Computed Tomography Image-Guided Robotic Surgery: A Preclinical Feasibility Study

• Published in: Journal of Neurological Surgery Part B: Skull Base Vol. 74; no. S 01
• Main Authors: Kim, Grace G., McKinney, Kibwei A., Ebert, Charles S., Zanation, Adam M.
• Format: Conference Proceeding Journal Article
• Language: English
• Published: 16.03.2013
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0033-1336213

Objectives: To describe the feasibility of using computed tomography (CT) image guidance in concert with the surgical robot in the anterior base of skull using endonasal and transoral approaches. Study Design: Prospective feasibility anatomic study on a human cadaveric skull and preoperative assessment in four human patients. Methods: In the cadaver skull and human patients, a robotic approach with the DaVinci surgical system to the anterior skull base was paired with CT image guidance. Preclinical studies combining synchronous image guidance and robotic movements measured the accuracy of robotic arm positioning to five anatomic sites of the external skull and anterior skull base using three instruments with different angles of rotations (0°, 40°, and 60°). Estimated systematic error was calculated and compared with achieved errors. Metachronous image guidance and the robotic system were observed using a transoral approach on four patients. Results: The cadaver model system approximated <1 mm accuracy using standard image guidance instruments and the 0° robotic arm positioning. However, increased angles of instruments from 20° to 60° on the robotic system revealed significant increases in error than estimated. Four surgical patients undergoing transoral robotic surgery had successful registration and accurate preoperative assessment using the image guidance system. They all demonstrated successful resection of anterior skull base masses with combined image guidance and robotic approaches. Conclusions: CT image guidance systems may be used in robotic approaches. Precise movements are improved by limiting the angle of deviation of instrument tips from the neutral position. Future studies will help optimize the combined technologies before validating the study in clinical settings.