Hybrid robotics for endoscopic skull base surgery: preclinical evaluation and surgeons' first impression

BACKGROUND: A robotic endoscope holder should theoretically provide various advantages in transnasal endoscopic skull base surgery, but only recently a robotic system has become commercially available. AIM OF THE STUDY: To provide a pre-clinical evaluation of potential advantages and surgeons' first impression of this robotic hybrid solution. METHODS: Thirty skull base surgeons, attending the Joint European Diploma of Endoscopic Skull Base Surgery 2018-2019 in Paris, were enrolled. A questionnaire, mainly concerning personal surgical experience and habits, was administered. The test phase consisted of two different dry-lab tasks, performed with and without EndoscopeRobot®, according to randomization and in two different days. A modified NASA-Task Load Index test was subsequently administered via e-mail to all participants. Completion times and modified GEARS-E scores of the videotaped tasks were recorded. RESULTS: Nineteen ENT-surgeons and eleven neurosurgeons, with different surgical habits and endoscopic experience, were enrolled. No-one appeared unfavorable a priori to robotic endoscopic surgery. While the robot did not provide an advantage in the simple grasping task 1, a trend towards better completion times and efficacy was evident in the bimanual task 2, when performed with the robot and bimanually. According to the modified NASA-Task Load Index test, surgeons felt more successful with the robot in task 2, finding it less stressful and mentally demanding. CONCLUSIONS: Endoscopic skull base surgeons seem to view a hybrid robotic solution positively. EndoscopeRobot® seems to provide a benefit to the single surgeon with experience in bimanual endoscopic surgery. Further pre-clinical and clinical evaluation of this technology is necessary.