Skull Base 2006; 16(3): 123-131
DOI: 10.1055/s-2006-939679
ORIGINAL ARTICLE

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

The Voice-Controlled Robotic Assist Scope Holder AESOP for the Endoscopic Approach to the Sella

Cherie-Ann O. Nathan1 , 2 , Vinaya Chakradeo1 , Kavita Malhotra1 , Horacio D'Agostino3 , Ravish Patwardhan4
  • 1Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
  • 2Head and Neck Surgical Oncology, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana
  • 3Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
  • 4Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
Further Information

Publication History

Publication Date:
17 May 2006 (online)

ABSTRACT

Objective: To evaluate the feasibility of using a voice-controlled robot Automated Endoscopic System for Optimal Positioning (AESOP) for holding and maneuvering the endoscope in the trans-sphenoidal approach to the pituitary. Design: To compare the manual approach to the voice-activated robotic scope holder in maneuvering the endoscope and resecting pituitary lesions using a two-handed technique. Setting: Robotic laboratory at Louisiana State University Health Sciences Center, Shreveport. Cadavers: Ten fresh cadaver heads. Main Outcome Measures: To determine the feasibility, advantages, and disadvantages of a single neurosurgeon maneuvering the endoscope, visualizing key anatomical features in the sphenoid, and resecting skull base lesions after the approach by an otolaryngologist. Results: The learning curve for utilization of the voice-controlled robotic arm was short. The compact cart with the AESOP took up little space and allowed the standard setup for this procedure. The elimination of the need for manual stabilization of the endoscope permitted the use of both hands for the actual procedure. The elimination of the tremor inherent with holding the endoscope manually allowed the scope to be placed closer to the target organ with fewer collisions. The most significant advantage was the ability of AESOP to save three anatomical positions, which could be returned to with a single voice command. Conclusions: Recently, the endoscopic-endonasal approach to the sella has gained popularity. The voice-activated robotic scope holder is safe and has several advantages over current scope holders. Its utility may reduce operating time and eliminate the need for a second surgeon to hold the endoscope.

REFERENCES

  • 1 Satava R M. Surgical robotics: the early chronicles: a personal historical perspective.  Surg Laparosc Endosc Percutan Tech. 2002;  12 6-16
  • 2 Satava R M. Robotic surgery: from past to future-a personal journey.  Surg Clin North Am. 2003;  83 1491-1500 , xii
  • 3 Kappert U, Cichon R, Schneider J et al.. Closed-chest coronary artery surgery on the beating heart with the use of a robotic system.  J Thorac Cardiovasc Surg. 2000;  120 809-811
  • 4 Hollands C M, Dixey L N. Applications of robotic surgery in pediatric patients.  Surg Laparosc Endosc Percutan Tech. 2002;  12 71-76
  • 5 Haus B M, Kambham N, Le D, Gourin C, Terris D J. Surgical robotic applications in otolaryngology.  Laryngoscope. 2003;  113 1139-1144
  • 6 Gourin C G, Terris D J. Surgical robotics in otolaryngology: expanding the technology envelope.  Curr Opin Otolaryngol Head Neck Surg. 2004;  12 204-208
  • 7 Nathan C O, Dixie L, Stucker F. Voice controlled robotic assist for endoscopic sinus surgery.  Otolaryngol Head Neck Surg. 2002;  127 57
  • 8 Gandhi C D, Post K D. Historical movements in transsphenoidal surgery.  Neurosurg Focus. 2001;  11 E7
  • 9 Collins W F. Hypophysectomy: historical and personal perspective.  Clin Neurosurg. 1974;  21 68-78
  • 10 Hardy J. Transsphenoidal hypophysectomy.  J Neurosurg. 1971;  34 582-594
  • 11 Jho H D, Ha H G. Endoscopic endonasal skull base surgery: Part 1-The midline anterior fossa skull base.  Minim Invasive Neurosurg. 2004;  47 1-8
  • 12 Jho H D, Ha H G. Endoscopic endonasal skull base surgery: Part 2-The cavernous sinus.  Minim Invasive Neurosurg. 2004;  47 9-15
  • 13 Jho H D, Ha H G. Endoscopic endonasal skull base surgery: Part 3-The clivus and posterior fossa.  Minim Invasive Neurosurg. 2004;  47 16-23
  • 14 Koren I, Hadar T, Rappaport Z H, Yaniv E. Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications.  Laryngoscope. 1999;  109 1838-1840
  • 15 Moses R L, Keane W M, Simeone Frederick et al.. Endoscopic transseptal transsphenoidal hypophysectomy with three-dimensional intraoperative localization technology.  Laryngoscope. 1999;  109 509-512
  • 16 Bumm K, Wurm J, Rachinger J et al.. An automated robotic approach with redundant navigation for minimal invasive extended transsphenoidal skull base surgery.  Minim Invasive Neurosurg. 2005;  48 159-164
  • 17 Tucker H M, Hahn J F. Transnasal transseptal sphenoidal approach to hypophysectomy.  Laryngoscope. 1982;  92 55-57
  • 18 Wilson W R, Khan A, Laws Jr E R. Transseptal approaches for pituitary surgery.  Laryngoscope. 1990;  100 817-819
  • 19 Carrau R L, Jho H D, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland.  Laryngoscope. 1996;  106 914-918
  • 20 Castelnuovo P, Pistochini A, Locatelli D. Different surgical approaches to the sellar region: focusing on the “two nostrils four hands technique.”  Rhinology. 2006;  44 2-7
  • 21 Kennedy D W. Functional endoscopic sinus surgery. Technique.  Arch Otolaryngol. 1985;  111 643-649
  • 22 Sethi D S, Pillay P K. Endoscopic surgery for pituitary tumors. In: Friedman M Operative Techniques in Otolaryngology-Head and Neck Surgery. 1996 7: 264-8
  • 23 Arnholt J L. Capt, Mair, Eric. A “third hand” for endoscopic skull base surgery.  Laryngoscope. 2002;  112 2244-2249
  • 24 Laws Jr E R. Vascular complications of transsphenoidal surgery.  Pituitary. 1999;  2 163-170
  • 25 Ciric I, Ragin A, Baumgartner C et al.. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience.  Neurosurgery. 1997;  40 225-236
  • 26 Jho H D, Alfieri A. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations.  Minim Invasive Neurosurg. 2001;  44 1-12
  • 27 Jho H D. Endoscopic endonasal approach to the optic.  Minim Invasive Neurosurg. 2001;  44 190-193
  • 28 Cappabianca P, Cavallo L M, Colao A et al.. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedure.  Minim Invasive Neurosurg. 2002;  45 193-200
  • 29 Kwoh Y S, Hou J, Jonckheere E A, Hayati S. A robot with improved absolute positioning accuracy for CT-guided stereotactic brain surgery.  IEEE Trans Biomed Eng. 1988;  35 153-160
  • 30 Davies B L, Hibberd R D, Coptcoat M J et al.. A surgeon robot prostatectomy-a laboratory evaluation.  J Med Eng Technol. 1989;  13 273-277

Cherie-Ann O NathanM.D. F.A.C.S. 

Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center

1501 Kings Hwy., Shreveport, LA 71130

Email: cnatha@lsuhsc.edu