Bots in the brain: advances in robotic keyhole neurosurgery

Advancements in robotics have facilitated the progression of patient outcomes and procedural proficiency in modern healthcare systems. However, keyhole transcranial endoscopic neurosurgery is a field where there are currently no full robotic systems in widespread clinical use. The mechanical requirements of neurosurgery and keyhole approach pathways must be considered for robotic development, with an emphasis on systems that embody simplicity, cost-effectiveness and efficacy. Mechanical force requirements for surgical instruments, ranging from <0.01N to 1.68N, emphasise the delicate quality of neurosurgery, and the consequently meticulous and careful instrument control that must be offered by robotic platforms. Current major keyhole approaches were investigated for cranial entry diameter, access to key anatomical corridors/spaces, pathologies treated, and limitations. The transparenchymal approach, as used with the Neuroendoport tubular retraction system, emerged as a potential candidate for robotic augmentation. After reviewing current systems and their pitfalls, prototypes in development – namely the NeuroCYCLOPS – were explored. Prototype testing with a peg transfer task, compared against rigid endoscopic instruments, revealed fewer instrument clashes and lower NASA-TLX scores. Although further research and development is warranted to develop this technology, these prototypes offer promise and lend encouragement for the future of robotics in endoscopic transcranial neurosurgery