Introduction: Based on our previously published reports on development and applications of robotic technology into microscopic neurosurgical procedures,1-7 the authors applied the supporting robotic device (Intelligent Arm Support System “iArmS®”) to endoscopic endonasal transsphenoidal surgery (ETSS) and evaluated its early clinical experience.

Methods: Herein, 43 patients with sellar region tumors were included (29 pituitary adenomas, 3 meningiomas, 3 Rathke’s cleft cysts, 2 craniopharyngiomas, 2 chordomas and 4 other lesions). Multimodality ETSS were applied to all patients. Supporting robot “iArmS ®’’ was used to maintain the surgeon’s endoscope-holding arm during nasal and sphenoid phases.

Results: The iArmS ® was a valuable tool for stabilizing the surgeon’s arm securely and following the surgeon’s arm-movement automatically. It decreased surgeon’s fatigue and eliminated shaking of the video image by providing a steady surgeon’s scope-holding hand. There were no complications relating to the use of iArmS ®.

Conclusions: As a novel of this study, the clinical results of robotic ETSS verified that our “iArmS®” is an effective device that improves preciseness and safety. Continued advances in robotics assure continued brisk evolution in neurosurgery.

Patient Care: 1-Improve preciseness and safety of complex ETSS procedures. 2-Allows delicate manipulation in such a deep and narrow operative filed. 3-Introduce a new robotic indispensable modality.

Learning Objectives: Robotic technology can become an indispensable modality during ETSS that allows a comfortable surgical environment, and provides a safe surgery based on the delicate manipulations which become available even in such a deep and narrow operative field.

References: 1. Goto T, Hongo K, Kakizawa Y, Muraoka H, Miyairi Y, Tanaka Y, Kobayashi S: Clinical application of robotic telemanipulation system in neurosurgery: case report. J Neurosurg. 99(6):1082-1084, 2003 2. Goto T, Hongo K, Yako T, Hara Y, Okamoto J, Toyoda K, Fujie MG, Iseki H: The concept and feasibility of EXPERT: intelligent armrest using robotics technology. Neurosurgery 72 Suppl 1:39-42, 2013 3. Hara Y, Goto T, Okamoto J, Okuda H, Iseki H, Hongo K: An armrest is effective for reducing hand tremble in neurosurgeons. Neurol Med Chir (Tokyo) 55:311-316, 2015 4. Hongo K, Goto T, Miyahara T, Kakizawa Y, Koyama J, Tanaka Y: Telecontrolled micromanipulator system (NeuRobot) for minimally invasive neurosurgery. Acta Neurochir Suppl 98:63-66, 2006 5. Hongo K, Kobayashi S, Kakizawa Y, Koyama J, Goto T, Okudera H, Kan K, Fujie MG, Iseki H, Takakura K: NeuRobot: telecontrolled micromanipulator system for minimally invasive microneurosurgery: preliminary results. Neurosurgery 51(4):985-988, 2002 6. Yako T, Goto T, Hongo K: Usefulness and limitation of a freely movable armrest in microneurosurgery. Int J Neurol Neurosurg. 1:185-190, 2009 7. Ogiwara T, Goto T, Nagm A, Hongo K. Endoscopic endonasal transsphenoidal surgery using the iArmS® operation support robot: initial experience in 43 patients. Neurosurg Focus. 2017 [In press]