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A Handheld Robot for Endoscopic Endonasal Skull Base Surgery: Updated Preclinical Validation Study (IDEAL Stage 0)
Joachim Starup-Hansen1,2, Nicola Newall1,2, Emmanouil Dimitrakakis2,3
1Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Journal of Neurological Surgery. Part B, Skull Base
|March 19, 2025
Summary
A new handheld robot shows promise for improving dexterity in endoscopic endonasal surgery (EES). Clinicians found the updated prototype feasible and acceptable, with potential for enhanced precision and reduced cognitive load in neurosurgical procedures.
Area of Science:
- Neurosurgery
- Robotics
- Medical Devices
Background:
- Endoscopic endonasal surgery (EES) is increasingly popular but technically challenging due to anatomical constraints and instrument limitations.
- A previous trial highlighted the potential of a robotic system for EES but indicated a need for improvements.
- This study evaluates an updated robotic prototype (version 0.2) for enhanced dexterity in neurosurgical procedures.
Purpose of the Study:
- To assess the feasibility and acceptability of an updated handheld robotic prototype for endoscopic neurosurgery.
- To compare the performance of the robotic prototype against standard instruments in preclinical settings.
- To evaluate the robotic system's potential to overcome dexterity challenges in EES.
Main Methods:
- A randomized crossover phantom study compared the robot to standard instruments for tumor resection.
- A cadaver-based user study assessed the robot's functional domains and clinical feasibility.
- Participants were stratified by neurosurgical experience, and statistical analyses included Mann-Whitney U tests and paired t-tests.
Main Results:
- The robotic system demonstrated a learning curve, achieving parity with traditional instruments by the fifth attempt.
- Most clinicians (7/8) preferred the robot, citing superior range, ergonomics, and precision.
- The robot showed a diminished cognitive workload and proved clinically feasible in cadaveric trials, with adequate workspace reach and force delivery.
Conclusions:
- The updated robotic prototype shows promising feasibility and acceptability for endoscopic endonasal surgery.
- Further iterative development is necessary before human clinical trials can commence.
- The robotic system has the potential to enhance dexterity and overcome limitations in current EES instruments.
