두개저 병변에 대한 내시경적 경비강 혹은 경안와 접근술에서 로봇 팔의 활용에 대한 초기 경험

Initial experience of electrical robotic holding arm during endoscopic endonasal or transorbital approach for skull base lesions

Background : Endoscope has improved dramatically and is currently utilized in all fields of neurosurgery. In particular, endoscope is widely used in skull base surgery. However, endoscope possesses innate limitation in which it should be operated manually. To overcome this problem, robotic holding system has been developed and its use is gradually expanding. Methods : Fifty cases in single institution from October to November, 2019 that underwent surgery with assistance by ENDOFIXexo (AKTORmed, Barbing, Germany) were analyzed to evaluate the effectiveness of robotic holding system. All operations were performed by the corresponding author. Results : Total 47 patients underwent operation and 50 cases, including 3 revisions due to cerebrospinal fluid leakage, were reviewed. The histological diagnoses included 35 pituitary adenomas, 7 meningiomas, 2 Rathke’s cleft cysts, 2 craniopharyngiomas, and 1 cavernous hemangioma. No severe or unexpected events such as swaying or fall down of robotic holding system were reported. Conclusions : ENDOFIXexo can be manipulated easily without any discomfort and no significant complications were found. From the study, we showed the effectiveness of the robotic holding system. Growing experience in using the robotic holding system will eventually accelerate the advance of the system and treatment outcome.