ArticleOperative neurosurgery (Hagerstown, Md.)2026
Applicability of a Dexterity-Enhancing Handheld Robot for 360° Endoscopic Skull Base Approaches: An Exploratory Cadaver Study.
Article in Operative neurosurgery (Hagerstown, Md.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesEndoscopic skull base surgery aims to reduce surgical morbidity by minimizing tissue manipulation and exposure. However, the anatomic constraints posed by the narrow surgical corridors and constrained operative workspace present technical challenges due to reduced dexterity. This study evaluates the applicability of a novel dexterity-enhancing handheld robot for endoscopic skull base approaches.
methodsThe robotic system is comprised of interchangeable articulated end-effectors coupled to a handheld controller. Two attending skull base neurosurgeons and 2 neurosurgery residents performed 8 skull base approaches on cadaveric specimens, spanning anterior, anterolateral, lateral, posterolateral, and posterior approaches. Conventional instruments were used to expose anatomic landmarks, followed by intraoperative tasks using the handheld robot. Participants were interviewed during the procedures to assess the robot's feasibility (ability to safely reach and perform its objective of manipulating tissue at the operative site) and usefulness (ability to perform desired objectives well).
resultsThe handheld robotic system was tested across 8 endoscopic skull base approaches, achieving feasibility in all cases. Superior workspace reach compared with standard instruments was demonstrated in 6 of 8 approaches. Tissue manipulation was satisfactory in all approaches. All surgeons reported that the current or a future device prototype could be useful across all 8 approaches. The most frequently cited advantage was the expanded dextrous workspace reach provided by the articulated end-effectors, particularly in approaches with long working channels, such as the endonasal approach. However, the robot encountered difficulties in transcranial approaches (trans-sylvian and subtemporal) due to the lack of shorter, curved shafts, which impaired visualization.
conclusionThe handheld robotic system demonstrated applicability across various endoscopic skull base approaches, offering increased dextrous workspace and effective tissue manipulation capabilities. Overall, this study supports the potential of handheld robots in endoscopic skull base surgery while highlighting the need for iterative development to optimize instrument design and functionality.
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