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首页> 外文期刊>Neurosurgical focus >Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications
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Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

机译：在颅神经外科手术中使用机器人操作的视频光学望远镜显微镜的初步经验：可行性，安全性和临床应用

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OBJECTIVE The move toward better, more effective optical visualization in the field of neurosurgery has been a focus of technological innovation. In this study, the authors’ objectives are to describe the feasibility and safety of a new robotic optical platform, namely, the robotically operated video optical telescopic-microscope (ROVOT-m), in cranial microsurgical applications. METHODS A prospective database comprising patients who underwent a cranial procedure between April 2015 and September 2016 was queried, and the first 200 patients who met the inclusion criteria were selected as the cohort for a retrospective chart review. Only adults who underwent microsurgical procedures in which the ROVOT-m was used were considered for the study. Preoperative, intraoperative, and postoperative data were retrieved from electronic medical records. The authors address the feasibility and safety of the ROVOT-m by studying various intraoperative variables and by reporting perioperative morbidity and mortality, respectively. To assess the learning curve, cranial procedures were categorized into 6 progressively increasing complexity groups. The main categories of pathology were I) intracerebral hemorrhages (ICHs); II) intraaxial tumors involving noneloquent regions or noncomplex extraaxial tumors; III) intraaxial tumors involving eloquent regions; IV) skull base pathologies; V) intraventricular lesions; and VI) cerebrovascular lesions. In addition, the entire cohort was evenly divided into early and late cohorts. RESULTS The patient cohort comprised 104 female (52%) and 96 male (48%) patients with a mean age of 56.7 years. The most common pathological entities encountered were neoplastic lesions (153, 76.5%), followed by ICH (20, 10%). The distribution of cases by complexity categories was 11.5%, 36.5%, 22%, 20%, 3.5%, and 6.5% for Categories I, II, II, IV, V, and VI, respectively. In all 200 cases, the surgical goal was achieved without the need for intraoperative conversion. Overall, the authors encountered 3 (1.5%) major neurological morbidities and 6 (3%) 30-day mortalities. Four of the 6 deaths were in the ICH group, resulting in a 1% mortality rate for the remainder of the cohort when excluding these patients. None of the intraoperative complications were considered to be attributable to the visualization provided by the ROVOT-m. When comparing the early and late cohorts, the authors noticed an increase in the proportion of higher-complexity surgeries (Categories IV–VI), from 23% in the early cohort, to 37% in the late cohort (p = 0.030). In addition, a significant reduction in operating room setup time was demonstrated (p CONCLUSIONS The feasibility and safety of the ROVOT-m was demonstrated in a wide range of cranial microsurgical applications. The authors report a gradual increase in case complexity over time, representing an incremental acquisition of experience with this technology. A learning curve of both setup and execution phases should be anticipated by new adopters of the robot system. Further prospective studies are required to address the efficacy of ROVOT-m. This system may play a role in neurosurgery as an integrated platform that is applicable to a variety of cranial procedures.
机译：目的在神经外科领域向更好，更有效的光学可视化发展一直是技术创新的重点。在这项研究中，作者的目的是描述在颅骨显微手术中使用新型机器人光学平台（即机器人操作的视频光学望远镜显微镜（ROVOT-m））的可行性和安全性。方法收集2015年4月至2016年9月期间接受颅骨手术的患者的前瞻性数据库，并选择前200名符合纳入标准的患者作为回顾性图表审查的队列。该研究仅考虑接受过ROVOT-m显微外科手术的成年人。从电子病历中检索术前，术中和术后数据。作者通过研究各种术中变量并分别报告围手术期发病率和死亡率来论述ROVOT-m的可行性和安全性。为了评估学习曲线，将颅骨手术分为6个逐渐增加的复杂性组。病理学的主要类别是：I）脑出血（ICH）; II）涉及非隆突区或非复杂性轴外肿瘤的轴内肿瘤; III）涉及雄辩区域的轴内肿瘤; IV）颅底病变; V）脑室内病变; VI）脑血管病变。此外，整个队列平均分为早期和晚期队列。结果该患者队列包括104位女性（52％）和96位男性（48％）患者，平均年龄为56.7岁。遇到的最常见病理实体是肿瘤性病变（153，76.5％），其次是ICH（20，10％）。 I，II，II，II，IV，V和VI类别按复杂度类别划分的案例分布分别为11.5％，36.5％，22％，20％，3.5％和6.5％。在所有200例病例中，无需进行术中转换即可达到手术目的。总体而言，作者遇到3例（1.5％）的主要神经系统疾病和6例（3％）的30天死亡率。 6例死亡中有4例为ICH组，排除这些患者后，其余队列的死亡率为1％。术中无并发症可归因于ROVOT-m提供的可视化。当比较早期和晚期队列时，作者注意到较高复杂性手术（IV-VI类）的比例从早期队列的23％增加到晚期队列的37％（p = 0.030）。此外，还证实了手术室设置时间的显着减少（p结论结论ROVOT-m在各种颅显微外科应用中的可行性和安全性得到了证明。作者报告说，随着时间的推移，病例的复杂性逐渐增加，该技术的经验积累;机器人系统的新使用者应预见设置和执行阶段的学习曲线;需要进一步的前瞻性研究以解决ROVOT-m的功效;该系统可能在神经外科中发挥作用作为适用于各种颅骨手术的集成平台。

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