Robotic Handle Prototypes for Endoscopic Endonasal Skull Base Surgery: Pre-clinical Randomised Controlled Trial of Performance and Ergonomics

Emmanouil Dimitrakakis,George Dwyer,Holly Aylmore,Danyal Z Khan,Hani J Marcus,Danail Stoyanov,Joshua Carmichael,Lukas Lindenroth,Neil L Dorward

doi:10.1007/s10439-022-02942-z

Abstract

Endoscopic endonasal skull base surgery is a promising alternative to transcranial approaches. However, standard instruments lack articulation, and thus, could benefit from robotic technologies. The aim of this study was to develop an ergonomic handle for a handheld robotic instrument intended to enhance this procedure. Two different prototypes were developed based on ergonomic guidelines within the literature. The first is a forearm-mounted handle that maps the surgeon’s wrist degrees-of-freedom to that of the robotic end-effector; the second is a joystick-and-trigger handle with a rotating body that places the joystick to the position most comfortable for the surgeon. These handles were incorporated into a custom-designed surgical virtual simulator and were assessed for their performance and ergonomics when compared with a standard neurosurgical grasper. The virtual task was performed by nine novices with all three devices as part of a randomised crossover user-study. Their performance and ergonomics were evaluated both subjectively by themselves and objectively by a validated observational checklist. Both handles outperformed the standard instrument with the rotating joystick-body handle offering the most substantial improvement in terms of balance between performance and ergonomics. Thus, it is deemed the more suitable device to drive instrumentation for endoscopic endonasal skull base surgery.

Highlights

Invasive neurosurgery is benefiting from robotic technology at a much slower rate than other surgical fields, due to anatomical and technical challenges.[15]
One such example of minimally invasive neurosurgery that could be enhanced by robotic technology is the Expanded Endoscopic Endonasal Approach (EEEA).[30]
To improve the design of the handles, it was suggested that the Rotating Joystick-Body Handle (RJH) incorporates a clicking joystick rather than a standard trigger, while the Forearm-Mounted Handle (FMH) would feel better with an articulated trigger or button controlling the trigger, rather than the pen-like rotating trigger that controls it in this current iteration

Summary

Introduction

Invasive neurosurgery is benefiting from robotic technology at a much slower rate than other surgical fields, due to anatomical and technical challenges.[15] One such example of minimally invasive neurosurgery that could be enhanced by robotic technology is the Expanded Endoscopic Endonasal Approach (EEEA).[30]. One of its main research disciplines concerns the development of teleoperated robotic platforms These platforms often employ concentric tube robots (CTR),[6,38,40] since their small diameter can help reach inaccessible areas inside the constrained surgical workspace at the base of the brain. Some of the main issues associated with CTRs in surgery are their distal-end dexterity and force-delivery capabilities.[26]. This is why the robotic systems intended for the endonasal approach often employ articulated miniature end-effectors.[1,9]. This is why the robotic systems intended for the endonasal approach often employ articulated miniature end-effectors.[1,9] These

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Conclusion