Introduction:
An increased number of scientific studies confirm that robot-assisted surgery facilitates the therapy of less accessible pathologies. In addition to surgical manipulation, robot-assisted visualization supports the surgeon by enabling bimanual instrumentation. This applies to endoscopic surgery of the sinuses and the middle ear. In this study, we present the application of an innovate robot-assisted endoscope holder in a preclinical cadaver setup.
Methods:
The system (Medineering GmbH, Munich, Germany) was tested on human cadaver heads without apparent pathologies, and sought to investigate applicability, controlling, visualization and patient safety. Control via foot pedal allows for endoscope guidance, leaving the surgeon with both hands free to operate instrumentation. Standard interventions were performed.
Results:
The system visualizes the intervention with adequate quality and stability, leaving both hands free to use instrumentation. Control is effectively precise and enables a sufficient and dynamic workflow. We successfully performed ethmoidectomy, maxillary antrostomy and sphenoidectomy with preparation of the anterior skull base, as well as tympanoskopy and mastoidectomy.
Conclusion:
The system enables bimanual instrumentation without additional assistance. As all manipulation is performed on sight, the risk of accidental damage does not appear to exceed that of conventional endoscope guidance. Future investigations will demonstrate whether the system will prevail in real situs with potential bleeding and high demand of dynamic instrumentation. CE-Marking is expected for November 2017, and we will report our first clinical findings.
