Dimitrakakis, Emmanouil; (2023) Handheld Robotic Instruments for Endoscopic Neurosurgery. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The Endoscopic Endonasal Approach, one of the best examples of endoscopic neurosurgery, allows surgeons to access the pituitary gland through the natural orifice of the nose. Recently, surgeons have introduced the Expanded Endoscopic Endonasal Approach for the treatment of tumours around a broader area at the base of the brain. Operating in this way, however, with standard tools which are lacking articulation, is technically very difficult and not widely adopted. Thus, these operations are only performed by few surgeons, in highly specialised centres, limiting access to most patients. While detection rates have increased due to recent advances in medical imaging, clinical outcome has not improved in the last 20 years. Resultantly, it is widely recognised by patient groups and healthcare institutions that there is an urgent need for surgical innovation to advance clinical outcomes in patients with brain tumours. Robotic-assisted minimally invasive surgery allows for increased instrument articulation and surgeon dexterity in operative workspaces with restricted access. Thus, it could be deemed as a suitable solution for these demanding approaches. This thesis explores the development of novel handheld robotic instruments for endoscopic neurosurgery. Initial work focused on the design of a miniature spherical-joint, robotic end-effector with the aim to expand the surgeon’s operative workspace and enhance their dexterity. To manipulate the end-effector, two concept handle prototypes were developed to cater to a large set of ergonomic literature suggestions. The two novel handles were compared as part of a pre-clinical randomised crossover user-study. This pre-existing work laid the foundation for a robotic system consisting of an ergonomically designed handheld controller, and a series of 3mm detachable end-effectors that was tested in a pre-clinical cadaver study and a multi-surgeon comparison phantom study. Peer-reviewed results on every developmental step suggest that the intended robotic instruments are a promising step towards developing appropriate instruments to drive endoscopic neurosurgery adoption.

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