An update on current devices for the port technique: A systematic review

The port technique for accessing deep lying brain lesions using tubular retractors is a relatively recent development. The use of tubular retractors in minimally invasive neurosurgery was first introduced in 1988 by Kelly et al. and since then the port technique for surgical access to deep brain anatomy has been developed. In the last three decades, multiple dedicated devices to facilitate the port technique have become available on the market. Currently, few articles compare the advantages and disadvantages, with Echeverry et al. performing the first formal comparison between three such devices: METRx, Vycor VBAsS and BrainPath in 2020. This systematic review aims to identify and summarise all devices for the port technique currently available in order to compare their benefits and limitations. Literature from PubMed, Cochrane Central Register of Controlled Trials and Cochrane database of systematic reviews were screened (last reviewed 5/7/2024) and analysed through a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The inclusion criteria were peer-reviewed English language journals, excluding reviews, reporting on the use of cranial retractors providing direct access to the brain and have been tested in adult humans. Thirty-three articles were selected for data extraction and analysis. Nine devices were identified including five currently available on the market (Aurora Surgiscope, BrainPath, cerebral corridor creators, METRx, Vycor VBAS) with a sixth (MindsEye) approaching commercialisation. All articles extracted were case series or reports (n = 335), but three clinical trials are currently ongoing (n = 364-639) thus indicating the need for further comparative studies. Risk of Bias was performed using the Oxford Centre for Evidence-Based Medicine tool. Type of lesion, rates of complication and gross total resection were measures used to compare devices. There was no statistically significant difference in complication rates between the nine devices identified. Clinical trial number: not applicable.