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. 2024 Jun 5:11:1400017.
doi: 10.3389/frobt.2024.1400017. eCollection 2024.

Handheld robotic device for endoscopic neurosurgery: system integration and pre-clinical evaluation

Emmanouil Dimitrakakis  1   2 , George Dwyer  2 , Nicola Newall  1   3 , Danyal Z Khan  1   3 , Hani J Marcus  1   2   3 , Danail Stoyanov  1   2
Affiliations

Handheld robotic device for endoscopic neurosurgery: system integration and pre-clinical evaluation

Emmanouil Dimitrakakis et al. Front Robot AI. .

Abstract

The Expanded Endoscopic Endonasal Approach, one of the best examples of endoscopic neurosurgery, allows access to the skull base through the natural orifice of the nostril. Current standard instruments lack articulation limiting operative access and surgeon dexterity, and thus, could benefit from robotic articulation. In this study, a handheld robotic system with a series of detachable end-effectors for this approach is presented. This system is comprised of interchangeable articulated 2/3 degrees-of-freedom 3 mm instruments that expand the operative workspace and enhance the surgeon's dexterity, an ergonomically designed handheld controller with a rotating joystick-body that can be placed at the position most comfortable for the user, and the accompanying control box. The robotic instruments were experimentally evaluated for their workspace, structural integrity, and force-delivery capabilities. The entire system was then tested in a pre-clinical context during a phantom feasibility test, followed up by a cadaveric pilot study by a cohort of surgeons of varied clinical experience. Results from this series of experiments suggested enhanced dexterity and adequate robustness that could be associated with feasibility in a clinical context, as well as improvement over current neurosurgical instruments.

Keywords: endonasal approach; endoscopic neurosurgery; handheld robotics; medical robotics; robotic neurosurgery.

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Conflict of interest statement

Authors ED, and GD are employed by Panda Surgical Limited. Authors ED, HM, and DS hold shares in Panda Surgical Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. ED and GD are supported by Panda Surgical Limited. The funder had the following involvement in the study: interpretation of data, the writing of this article, and the decision to submit it for publication.

Figures

FIGURE 1
FIGURE 1
(A) The handheld robotic instrument deploying a grasper, alongside three other articulated tools; a flat dissector, a ring-curette, and an endoscope, and (B) the handheld device used in a simulated cadaveric operation of the endonasal approach.
FIGURE 2
FIGURE 2
(A) The miniature grasper end-effector, and (B) the tendon-routing of the 3 DoF, alongside the coordinate system of the joint DoF.
FIGURE 3
FIGURE 3
(A) The tendon-routing system for a single DoF with the other two DoF tendons following similar routing paths, (B) the differential gearing system, highlighted in grey, with tendons for a single DoF, (C) the coupling on the handheld controller side, and (D) the coupling on the end-effector side.
FIGURE 4
FIGURE 4
(A) The routing system inside an open end-effector casing, and (B) the fully assembled grasper end-effector.
FIGURE 5
FIGURE 5
(A) (Top to bottom) The articulated end-effectors, namely, the ring-curette, the grasper, the endoscope, and the spatula dissector, and (B) Top row—The articulated endoscope inside a pituitary anatomy phantom at three different angles. Bottom row—the accompanying views from the camera. The dark spot seen in the top row of pictures is a magnet used for the phantom assembly, not to be confused with the simulated tumor evident in the bottom row.
FIGURE 6
FIGURE 6
Renderings of (A). The concept handheld design suggested in Dimitrakakis et al. (2022) tested in simulation, and (B) The finalised handheld instrument design after electronics, motors, and end-effectors were incorporated to offer functionality.
FIGURE 7
FIGURE 7
The rotating joystick-body in its 5 discrete positions with a rotating step of 15 ° .
FIGURE 8
FIGURE 8
The control box housing all the electronics.
FIGURE 9
FIGURE 9
(A) Structural integrity test experimental setup, and (B) Phantom feasibility test experimental setup.
FIGURE 10
FIGURE 10
(A). The grasper end-effector at two different joint-space limits, (B). The ring-curette end-effector at two different joint-space limits, (C). The overall joint-spaces of both end-effectors, and (D). The ring-curette end-effector maintaining its pose holding a 500 g weight.
FIGURE 11
FIGURE 11
The view from the USB-endoscope during the phantom feasibility study where the silicone tumor at the pituitary gland region was removed with the use of (A)The robotic grasper, (B)The robotic ring-curette, and (C)The robotic dissector.
FIGURE 12
FIGURE 12
(A) The surgical setup with the introduction of the novel robotic instrument, and (B) (left to right) A standard suction tool, and the robotic curette in different poses interacting with soft tissue.
FIGURE 13
FIGURE 13
(A) Concurrent usage of the robotic ring-curette and the robotic endoscope, while in visual guidance from the standard neuroendoscope, (B) View of the sellar anatomy using the articulated endoscope, in its initial pose, and (C) View of the sellar anatomy using the articulated endoscope, having it actuated on the yaw axis.
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