Robotic Surgical Approach to the Mesial Temporal Region: A Preliminary Three-Dimensional Cadaveric Study of Technical Feasibility

World Neurosurg. 2020 Dec;144:e40-e52. doi: 10.1016/j.wneu.2020.07.153. Epub 2020 Jul 27.

Abstract

Objective: Robotic surgical systems are used worldwide in various fields. In this study, we present the advantages and disadvantages of the most common robotic surgical system, the da Vinci Xi system, in the supracerebellar transtentorial approach to the mesial temporal region and discuss options for its integration into neurosurgery.

Methods: Our study was conducted at the Advanced Simulation and Applied Endoscopic Surgery Training and Research Center and Anatomy Laboratory. Four formalin-fixed human cadaveric head specimens with red silicone dye injected into their arterial structures and blue silicone dye injected into their venous structures were used in the study. Dissections were performed in microscopic and robotic stages. All phases were photographed using a three-dimensional photographic technique.

Results: The mesial temporal lobe could be accessed via the supracerebellar transtentorial route with the use of the robotic system. We show that the robotic system can be used in difficult approaches and narrow regions with a wider exposure and superior image quality than with the microscopic approach, improving the ergonomics for the surgeon. The shortcomings of robotic systems are examined and innovative solutions are offered.

Conclusions: This study shows the advantages and disadvantages of the robotic surgical approach to the mesial temporal region via the supracerebellar transtentorial route. Robotic surgical systems can play a major role in neurosurgical practices with the tools designed and the innovative solutions determined in this study. Nevertheless, further research and development of these systems and related instruments are necessary to ensure their wider implementation in neurosurgery.

Keywords: Anatomic dissection; Mesial temporal lobe surgery; Robot-assisted surgery; Surgical technique; da Vinci Xi robotic surgery system.

MeSH terms

  • Cadaver
  • Cerebellum / anatomy & histology
  • Computer Simulation
  • Endoscopy / methods
  • Ergonomics
  • Feasibility Studies
  • Humans
  • Imaging, Three-Dimensional
  • Microdissection
  • Robotic Surgical Procedures* / instrumentation
  • Temporal Lobe / anatomy & histology*
  • Temporal Lobe / surgery*