A Feasibility Study on the use of Concentric Tube Continuum Robots for Endonasal Skull Base Tumor Removal

Gilbert, Hunter B; Swaney, Philip J; Burgner, Jessica; Weaver, Kyle D; Russell III, Pail T; Webster III, Robert J
The Hamlyn Symposium on Medical Robotics, pp. 1-2, 2012
A Feasibility Study on the use of Concentric Tube Continuum Robots for Endonasal Skull Base Tumor Removal


We evaluate the ability of a robotic system with needle-diameter, tentacle-like manipulators [1] to remove pituitary tumors endonsally. The robot consists of precurved superelastic tubes that can be axially rotated and telescopically extendedto create controllable bending and elongation of the manipulator.Pituitary tumors account for 15-20% of all diagnosed primary brain tumors [2], and 1 in 5 people are likely to have one in their lifetime [2], with 1 in 120 of these growing large enough (>1cm) to require surgery[3]. In contrast to traditional transcranial and transfacial surgical approaches, the endonasal approach results in no disfigurement to the patient; rather than entering through large tunnels bored into the patient’sforehead or cheek, surgical instruments enter through the patient’s nostril(s). However, the endonasal procedure is only deployed in a small fraction of all pituitary tumor casesbecause of the challenge of manuallymanipulating multiple straight, rigid instruments through theconstrained nostril entry port, while performing complex surgical motionsat the skull base. Arobotic approach to this procedure has the potential to reduce technical barriers and bring the benefits of endonasal surgery to many more patients. As has been demonstrated in other surgical applications, robots can do this by accurately manipulating small tools (e.g. [4]) andenhancingdexterity (e.g. [5])in constrained spaces inside the patient. Systems have recently been introduced specifically for middle ear surgery [4], throat surgery [5], among others. Endonasal surgery is a particularly challenging application for arobotic system, because of the small nostril access port and the dexterity required at the skull base. Some prior results exist on use of robotic systems to aidin bone drilling to open access paths to the skull base (see e.g. [6]), and toassistinendoscope manipulation [7]. These are complementary to our approach [1], which is deployed after the surgical site is opened.