Robotics in Keyhole Transcranial Endoscope-Assisted Microsurgery

Marcus, Hani J.; Seneci, Carlo A.; Nandi, Dipankar; Darzi, Ara; Yang, Guang‐Zhong

doi:10.1227/neu.0000000000000123

Cited by 28 publications

(24 citation statements)

References 81 publications

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“…Alternatively, non-specific bleeding, blood pressure, and coagulation management may be responsible for this effect. Nevertheless, the generalizability of our findings need to be confirmed by ongoing RCTs and other neurosurgical groups, considering the higher cost and greater challenges that we noted in regard to logistics, setup, workflow, and technical skill, which fall in line with other MIS techniques [25,31].…”

Section: Effectiveness Of Navigated Endoscopy-assisted Mechanical Frmentioning

confidence: 56%

Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage

et al. 2020

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Background Minimally invasive surgery (MIS) for evacuation of spontaneous intracerebral hemorrhage (ICH) has shown promise but there remains a need for intraoperative performance assessment considering the wide range of evacuation effectiveness. In this feasibility study, we analyzed the benefit of intraoperative 3-dimensional imaging during navigated endoscopyassisted ICH evacuation by mechanical clot fragmentation and aspiration. Methods 18 patients with superficial or deep supratentorial ICH underwent MIS for clot evacuation followed by intraoperative computerized tomography (iCT) or cone-beam CT (CBCT) imaging. Eligibility for MIS required (a) availability of intraoperative iCT or CBCT, (b) spontaneous lobar or deep ICH without vascular pathology, (c) a stable ICH volume (20-90 ml), (d) a reduced level of consciousness (GCS 5-14), and (e) a premorbid mRS ≤ 1. Demographic, clinical, and radiographic patient data were analyzed by two independent observers. Results Nine female and 9 male patients with a median age of 76 years (42-85) presented with an ICH score of 3 (1-4), GCS of 10 (5-14) and ICH volume of 54 ± 26 ml. Clot fragmentation and aspiration was feasible in all cases and intraoperative imaging determined an overall evacuation rate of 80 ± 19% (residual hematoma volume: 13 ± 17 ml; p < 0.0001 vs. Pre-OP). Based on the intraoperative imaging results, 1/3rd of all patients underwent an immediate re-aspiration attempt. No patient experienced hemorrhagic complications or required conversion to open craniotomy. However, routine postoperative CT imaging revealed early hematoma re-expansion with an adjusted evacuation rate of 59 ± 30% (residual hematoma volume: 26 ± 37 ml; p < 0.001 vs. Pre-OP). Conclusions Routine utilization of iCT or CBCT imaging in MIS for ICH permits direct surgical performance assessment and the chance for immediate re-aspiration, which may optimize targeting of an ideal residual hematoma volume and reduce secondary revision rates.

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Section: Effectiveness Of Navigated Endoscopy-assisted Mechanical Frmentioning

confidence: 56%

Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage

et al. 2020

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“…The robotic systems used to address the challenges of NOTES and SPA present complex mechanical architectures due to the stringent operational constraints and high number of actuated joints used to provide the necessary kinematic dexterity in confined spaces. Detailed reviews of these systems have been included in [20,21,22,23,24]. In this section, we briefly present an overview of the mechanical architectures used to the extent needed to outline their associated modeling and control challenges.…”

Section: Surgical Systems For Notes and Single Port Access Surgerymentioning

confidence: 99%

Medical Technologies and Challenges of Robot-Assisted Minimally Invasive Intervention and Diagnostics

Simaan

Yasin

Wang

2018

Annu. Rev. Control Robot. Auton. Syst.

144

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Emerging paradigms furthering the reach of medical technology deeper into human anatomy present unique modeling, control and sensing problems. This paper discusses a brief history of medical robotics leading to the current trend of minimally invasive intervention and diagnostics in confined spaces. Robotics for natural orifice and single port access surgery, capsule and magnetically actuated robotics and microrobotics are discussed with the aim of elucidating the state of the art. Works on modeling, sensing and control of mechanical architectures of robots for natural orifice and single port access surgery are discussed, followed by a presentation of works on magnetic actuation, sensing and localization for capsule robotics and microrobotics. Finally challenges and open problems in each one of these areas are presented.

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“…Nevertheless, there is still room for improvement, particularly in terms of cost reduction and the development of smaller and more powerful robotic systems [3], [51] and [52].…”

Section: Robotics In the Neurosurgery Fieldmentioning

confidence: 99%

Neurosurgery and brain shift: review of the state of the art and main contributions of robotics

Correa-Arana

Vivas-Albán

Navarro

2017

TecnoL.

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This paper presents a review about neurosurgery, robotic assistants in this type of procedure, and the approach to the problem of brain tissue displacement, including techniques for obtaining medical images. It is especially focused on the phenomenon of brain displacement, commonly known as brain shift, which causes a loss of reference between the preoperative images and the volumes to be treated during image-guided surgery. Hypothetically, with brain shift prediction and correction for the neuronavigation system, minimal invasion trajectories could be planned and shortened. This would reduce damage to functional tissues and possibly lower the morbidity and mortality in delicate and demanding medical procedures such as the removal of a brain tumor. This paper also mentions other issues associated with neurosurgery and shows the way robotized systems have helped solve these problems. Finally, it highlights the future perspectives of neurosurgery, a branch of medicine that seeks to treat the ailments of the main organ of the human body from the perspective of many disciplines.

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Robotics in Keyhole Transcranial Endoscope-Assisted Microsurgery

Abstract: New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.

Cited by 28 publications

References 81 publications

Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage

Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage

Medical Technologies and Challenges of Robot-Assisted Minimally Invasive Intervention and Diagnostics

Neurosurgery and brain shift: review of the state of the art and main contributions of robotics

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