Abstract
The goal of this cadaver study was to evaluate the feasibility and safety of da Vinci robot-assisted keyhole neurosurgery. Several keyhole craniotomies were fashioned including supraorbital subfrontal, retrosigmoid and supracerebellar infratentorial. In each case, a simple durotomy was performed, and the flap was retracted. The da Vinci surgical system was then used to perform arachnoid dissection towards the deep-seated intracranial cisterns. It was not possible to simultaneously pass the 12-mm endoscope and instruments through the keyhole craniotomy in any of the approaches performed, limiting visualization. The articulated instruments provided greater dexterity than existing tools, but the instrument arms could not be placed in parallel through the keyhole craniotomy and, therefore, could not be advanced to the deep cisterns without significant clashing. The da Vinci console offered considerable ergonomic advantages over the existing operating room arrangement, allowing the operating surgeon to remain non-sterile and seated comfortably throughout the procedure. However, the lack of haptic feedback was a notable limitation. In conclusion, while robotic platforms have the potential to greatly enhance the performance of transcranial approaches, there is strong justification for research into next-generation robots, better suited to keyhole neurosurgery.
Highlights
Robotic platforms that further enhance surgical skills have the potential to improve the safety and efficacy of keyhole neurosurgery [9, 11, 22]
The endoscope had to be placed outside the craniotomy, limiting the illumination, magnification, and wide-angle view provided
The large instrument arms could not be placed in parallel through the keyhole craniotomy and, could not be advanced to the deep cisterns without significant clashing (Fig. 1)
Summary
Robotic platforms that further enhance surgical skills have the potential to improve the safety and efficacy of keyhole neurosurgery [9, 11, 22]. The most widely used surgical robot worldwide is the da Vinci system (Intuitive Surgical, CA, USA), a master-slave system designed for minimally invasive surgery (MIS) in which the surgeon remotely controls the robots’ actions (Fig. 1). The camera arm includes two lenses, providing surgeons with a high-resolution stereoscopic image of the operative field. The instrument arms contain articulated endo-wrists, which increase surgical dexterity. The da Vinci system has been used in a broad range of procedures [2, 12] and has achieved substantial clinical penetration in fields such as urology [5, 13]
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