eprintid: 10190946 rev_number: 8 eprint_status: archive userid: 699 dir: disk0/10/19/09/46 datestamp: 2024-04-19 12:55:42 lastmod: 2024-04-19 12:55:42 status_changed: 2024-04-19 12:55:42 type: article metadata_visibility: show sword_depositor: 699 creators_name: Starup-Hansen, Joachim creators_name: Newall, Nicola creators_name: Dimitrakakis, Emmanouil creators_name: Khan, Danyal Z creators_name: Dwyer, George creators_name: Iyengar, Keshav creators_name: Psychogyios, Dimitrios creators_name: Hanrahan, John G creators_name: Sinha, Siddharth creators_name: Booker, James creators_name: Stoyanov, Danail creators_name: Marcus, Hani J title: A Handheld Robot for Endoscopic Endonasal Skull Base Surgery: Updated Preclinical Validation Study (IDEAL Stage 0) ispublished: inpress divisions: UCL divisions: B02 divisions: B04 divisions: C07 divisions: C05 divisions: D07 divisions: F48 divisions: F42 divisions: F85 keywords: Endoscopic neurosurgery - pituitary surgery - robotic surgery - skull base note: Copyright © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). abstract: Background and Objectives: Endoscopic endonasal surgery (EES) has become increasingly popular, yet anatomical constraints posed by the nose and limitations of nonarticulated instruments render EES technically challenging, with a steep associated learning curve. Therefore, we developed a handheld robot to enhance dexterity in endoscopic neurosurgical procedures. A previous trial of the robot demonstrated its potential advantages in endoscopic neurosurgery but also the need for improvements. In this study, we assess the feasibility, acceptability, and comparative performance of the updated robotic prototype (version 0.2) against standard instruments in a preclinical phantom and cadaveric trial. // Methods: Ethical approval was received. Participants were stratified according to their neurosurgical experience. In the phantom study, a randomized crossover design compared the robot against standard instruments at a phantom tumor resection task. Statistical analysis was performed using Mann–Whitney U tests and paired t-tests. In the cadaver-based user study, participants evaluated the device's functional domains through a qualitative interview design. // Results: In the phantom study, the device demonstrated a learning curve: initial resection attempts favored the traditional instrument (84% vs. 59%, p = 0.055), but parity was achieved by the fifth attempt (80% vs. 83%, p = 0.76). Acceptability was evident, as most clinicians (7/8) preferred the robot for its superior range, ergonomics, and precision. Also, the robot exhibited a diminished cognitive workload. The cadaveric study underscored the robot's clinical feasibility, through sufficient workspace reach and force delivery. // Conclusion: Overall, our robot demonstrates promising acceptability and feasibility for endoscopic neurosurgery, yet further iterative developments are required before proceeding to in-human clinical trials. date: 2024-04-15 date_type: published publisher: Georg Thieme Verlag KG official_url: http://dx.doi.org/10.1055/a-2297-3647 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2268327 doi: 10.1055/a-2297-3647 lyricists_name: Marcus, Hani lyricists_name: Dimitrakakis, Emmanouil lyricists_name: Iyengar, Keshav lyricists_name: Psychogyios, Dimitrios lyricists_name: Khan, Danyal Z lyricists_id: HJMAR16 lyricists_id: MDIMI11 lyricists_id: KKIYE80 lyricists_id: DPSYC66 lyricists_id: DKHAN91 actors_name: Bracey, Alan actors_id: ABBRA90 actors_role: owner full_text_status: public publication: Journal of Neurological Surgery Part B: Skull Base issn: 2193-6331 citation: Starup-Hansen, Joachim; Newall, Nicola; Dimitrakakis, Emmanouil; Khan, Danyal Z; Dwyer, George; Iyengar, Keshav; Psychogyios, Dimitrios; ... Marcus, Hani J; + view all <#> Starup-Hansen, Joachim; Newall, Nicola; Dimitrakakis, Emmanouil; Khan, Danyal Z; Dwyer, George; Iyengar, Keshav; Psychogyios, Dimitrios; Hanrahan, John G; Sinha, Siddharth; Booker, James; Stoyanov, Danail; Marcus, Hani J; - view fewer <#> (2024) A Handheld Robot for Endoscopic Endonasal Skull Base Surgery: Updated Preclinical Validation Study (IDEAL Stage 0). Journal of Neurological Surgery Part B: Skull Base 10.1055/a-2297-3647 <https://doi.org/10.1055/a-2297-3647>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10190946/1/a-2297-3647.pdf