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

Nathan et al used the AESOP robotic arm to support and move the endoscope in conjunction with InstaTrak^® image guidance to expose the sella in 10 fresh cadaveric heads. In terms of technique, their recommendations, which are based on their experience, appear to be quite helpful. They conclude that voice-activated robotics is safe and efficient for use with an endoscopic approach to the pituitary. If this level of safety and efficiency can be reproduced in patients, the technology will represent a significant advance.

The authors do not address the surgeon's ability to perform a selective adenomectomy of functioning tumors or complete removal of macroadenomas as safely and completely as is now possible with the microscope in experienced hands. I continue to perform endoscopic-assisted microsurgery, primarily relying on the microscope for tumor removal and using the endoscope to “see around corners.” I also use image guidance for reoperations, for large tumors that involve the cavernous sinus, and for extended trans-sphenoidal approaches.

Nonetheless, the authors have demonstrated a possible improvement in technology that may prove helpful. Based on this article, I plan to investigate the possibility of using AESOP. The authors have added new technology needed to improve the efficacy of endoscopic trans-sphenoidal surgery.