Robot-assisted navigated neuroendoscopy

OBJECTIVE: Major steps in the evolution of advanced neurosurgical techniques include microneurosurgery, neuroendoscopy and its minimally invasive variations, neuronavigation, and advanced intraoperative imaging. With traditional neuroendoscopic techniques (e.g., freehand endoscopy or the use of mechanical arms), definitive controlled movement of the endoscope within the brain depends on the experience and skill of the individual neurosurgeon. METHODS: With the Evolution 1 precision robot (Universal Robot Systems, Schwerin, Germany), a new neurosurgical tool has become available for the precise steering of instruments within the cranium. After preclinical anatomic and precision studies, the system was used for neuronavigated endoscopic procedures for three patients. RESULTS: All robot-assisted, navigated, endoscopic procedures were successfully completed. The time for the registration procedure and setup of the robot decreased from 60 minutes for the first patient to 30 minutes for the third patient. The time for the surgical part of the endoscopic procedure ranged from 17 to 65 minutes. No complications occurred during any procedure. CONCLUSION: The use of robotic technology for neuroendoscopic procedures is a major advance for controlled movement of the endoscope within the cranium. The start-up procedure and calibration of the robot are still time-consuming, but the actual operation time is comparable to that of freehand neuroendoscopic procedures. Steering of the endoscope is facilitated, and the precision of the endoscopic movements is noteworthy.