AB028. Precision neurosurgery for brain tumors using robotic navigation under exoscope.

Background: Three-dimensional (3D) exoscope and navigation systems have recently become remarkably advanced in neurosurgery. Robotic navigation is being used in various facilities. Based on the created surgical plan, robotic navigation automatically determines the path to guide the instrument. It seamlessly integrates with continuous real-time navigation and robotic alignment functions to improve the efficiency of intraoperative workflow and support highly accurate positioning. We have achieved good results in surgeries utilizing robotic navigation at our institution, and we report on the results and prospects.

Methods: At our hospital, 15 patients underwent surgery using Stealth AutoguideTM (Medtronic) in conjunction with the StealthStation S8 (Medtronic). The mean age was 56.2 years; 10 were men, and five were women. We used the exoscopic systems with KINEVO 900 (Zeiss) or ORBEYE (Olympus).

Results: The cases comprised of 11 gliomas, two primary central nervous system lymphomas, one germ cell tumor, and one brain abscess. Seven biopsies (six burr holes, one craniotomy) and six fence posts were used for Stealth AutoguideTM, tubing in two cases. Biopsies were performed quickly and reliably. In the cases where fence posts were used, it was possible to position the post quickly on the target and place it accurately in the planned area to determine the extent of removal. In addition, using the 3D exoscope system allowed the surgeon to simultaneously view the operating field and navigation screen without moving the surgeon's line of sight, making the operation safer.

Conclusions: Surgery using robotic navigation was performed safely and efficiently, and highly accurate positioning was achieved regardless of the surgical technique. This system is expected to continue improving the accuracy, safety, and reproducibility of surgery and reducing the burden on the patient.