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. 2015 Apr;76(4):479-84; discussion 484.
doi: 10.1227/NEU.0000000000000623.

An experimental feasibility study on robotic endonasal telesurgery

Raul Wirz  1 , Luis G Torres, Philip J Swaney, Hunter Gilbert, Ron Alterovitz, Robert J Webster 3rd, Kyle D Weaver, Paul T Russell 3rd
Affiliations

An experimental feasibility study on robotic endonasal telesurgery

Raul Wirz et al. Neurosurgery. 2015 Apr.

Abstract

Background: Novel robots have recently been developed specifically for endonasal surgery. They can deliver several thin, tentacle-like surgical instruments through a single nostril. Among the many potential advantages of such a robotic system is the prospect of telesurgery over long distances.

Objective: To describe a phantom pituitary tumor removal done by a surgeon in Nashville, Tennessee, controlling a robot located approximately 800 km away in Chapel Hill, North Carolina, the first remote telesurgery experiment involving tentacle-like concentric tube manipulators.

Methods: A phantom pituitary tumor removal experiment was conducted twice, once locally and once remotely, with the robotic system. Robot commands and video were transmitted across the Internet. The latency of the system was evaluated quantitatively in both local and remote cases to determine the effect of the 800-km distance between the surgeon and robot.

Results: We measured a control and video latency of < 100 milliseconds in the remote case. Qualitatively, the surgeon was able to carry out the experiment easily and observed no discernable difference between the remote and local cases.

Conclusion: Telesurgery over long distances is feasible with this robotic system. In the longer term, this may enable expert skull base surgeons to help many more patients by performing surgeries remotely over long distances.

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Figures

Figure 1
Figure 1
An active cannula gripper together with a DaVinci gripper.
Figure 2
Figure 2
Setup trial of transnasal skull base surgery robot system in a human cadaver head and the endoscopic view of the pituitary gland.
Figure 3
Figure 3
The left two images show the endoscope view of the curette in the sella and the setup of the robot with the skull. The two experimental conditions (local and remote) are illustrated in the central square, with the surgeon interface indicated on the rightmost image.
Figure 4
Figure 4
(A) Surgeon in Nashville using a robot located in North Carolina to remove phantom pituitary tissue. (B) Experimental setup of the local experiment with both the robot and surgeon at Vanderbilt.
Figure 4
Figure 4
(A) Surgeon in Nashville using a robot located in North Carolina to remove phantom pituitary tissue. (B) Experimental setup of the local experiment with both the robot and surgeon at Vanderbilt.
Figure 5
Figure 5
Setup trial of transnasal skull base surgery robot system with the endoscopic view of the phantom tumor and the Sella.
Figure 6
Figure 6
The Latency in the surgeon’s control commands for both experiments
Figure 7
Figure 7
Sample of IAT for the same time period shown in Figure 6. The moving average over 5 packets is shown.
See this image and copyright information in PMC

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