Introduction: Endoscopic brain tumor removal has recently been introduced and clinically performed in the neurosurgical field. Kassam et al. introduced the tubular surgery for resection of deep brain tumor using a tubular corridor and an endoscope.Limitations of the endoscopic tubular surgery are a diminished field of view, collisions between instruments and unexpected brain injury. These problems can be resolved through the 3D endoscopic telesurgical robot system.
Methods: We selected the commercialized product (Phantom Omni, Sensable Inc., USA) as the master device. Slave device has 20mm diameter following corridor’s size with two end-effectors and one stereo endoscope of 10mm diameter. One end-effector is a 5DOF gripper (1 translation, 3 rotations, 1 grip). The other is a 4DOF suction (1 translation, 3 rotations). Navigation software can manage pre- and intraoperative steps. A hemispherical acrylic phantom was created to mimic a human head with a near 20cm diameter. To appropriately represent a tumor, a single acrylic sphere with a 5cm diameter was arbitrarily positioned within the phantom using an acrylic cylinder with a 22mm inner diameter.
Results: Using the phantom and the robot system, authors simulated 3D endoscopic telesurgical tumor removal. In the preoperative step, the software stored the data of lesion volumes and trajectories from extracranial region to tumor using preoperative volume image. In the intraoperative step, registration process that matched between image and robot coordinates is performed using optical tracking system. Based on the matching data, the software observed real-time positions of end-effectors and the lesion so that can prohibit unexpected collisions and invasions to normal tissues. Surgeon could perform the task using the system with 3D monitor and additional display of real-time situation
Conclusions: Authors has been developing 3D endoscopic telesurgical robot system. Through this experiment, we validated the feasibility of the system and might be expecting to clinical application.
Patient Care: Improve surgical result
Diminish surgical complication
Expand the field of MIS
Learning Objectives: Application of surgical robot in the field of neurosurgery.
Real time graphic display during the operation
Safety of robotic surgery