Robotics in endoscopic transnasal skull base surgery: Literature review and personal experience

Abstract Robotics has already been applied to several surgical fields, but only transoral robotic surgery has a recognized role in skull base surgery. Different preclinical prototypes have been described for endoscopic transnasal skull base surgery (ESBS), but only recently a dedicated, hybrid robotic system has become available for clinical practice. This chapter reviews the use of holders in neurosurgery and skull base surgery, provides an overview of limitations of previous robotic systems that were designed for other surgical applications, describes the different preclinical robotic prototypes that have been developed for ESBS, and reports the initial preclinical and clinical experience with a novel, dedicated, hybrid robotic solution for endoscopic skull base surgery (EndoscopeRobot®, Medineering, Munich, Germany). The era of robotics in skull base surgery is at its dawn, but advantages of the hybrid solution are already evident, though further studies are needed to gain additional data.