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Feasibility of Robotic Transorbital Surgery
Min Ho Lee1,2, Limin Xiao1,3, Juan C Fernandez-Miranda1
1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto , California , USA.
Operative Neurosurgery (Hagerstown, Md.)
|August 29, 2024
Summary
Robotic-assisted surgery using the lateral transorbital approach (TOA) is not yet feasible due to large instruments. Future tool development could enable wider application in neurosurgery.
Area of Science:
- Neurosurgery
- Robotic Surgery
- Surgical Anatomy
Background:
- The lateral transorbital approach (TOA) offers access to pathologies near the optic nerve, challenging for endonasal methods.
- Investigating robotic assistance for lateral TOA is crucial for expanding surgical capabilities.
Purpose of the Study:
- To assess the feasibility of robotic-assisted surgery via the lateral transorbital approach.
- To evaluate the surgical access and angles to key neuroanatomical targets.
Main Methods:
- Dissection of six human postmortem heads using the DaVinci Xi robotic system.
- Targeting the superior orbital fissure (V1), foramen ovale (V3), and trigeminal ganglion root.
- Measuring distances and angles from the entry point to surgical targets.
Main Results:
- Median distances to targets ranged from 55 mm (V1) to 76 mm (trigeminal ganglion root).
- Median surgical angles were 19.1° horizontally and 16.5° vertically.
- Current robotic instruments are too large for effective lateral TOA.
Conclusions:
- Robotic-assisted lateral TOA is currently premature due to instrument size limitations.
- The wide internal surgical space of the lateral TOA suggests potential with optimized, smaller surgical tools.
