Analysis of Endonasal Endoscopic Transsphenoidal (EET) surgery pathway and workspace for path guiding robot design

Background: Endoscopic Endonasal Transsphenoidal Surgery (EETS) is the standard method to treat pituitary adenoma, tumor in the pituitary gland which would affect human beings in terms of hormonal malfunction and other symptoms. This procedure provides extra minimal invasive access in severe cases. The objective of this paper is to design and develop a prototype of EET robot with navigation guidance system based on the study of EET workspace and pathway to determine a safe space for surgical tool insertion. Methods: The EET workspace and its pathway were studied via data collected from EET experiments on 70 cadavers. An optical tracking system was used to detect and record the movement of the surgical tools during the experiments. Delaunay triangulation and Voronoi diagram were utilized to determine the cloud position of the gathered data for EET workspace. Moreover, in order to determine the EET pathway voxelization methods were incorporated. Results: The average diameter of the workspace calculated was 19.08 with 3.32 S. D, the average length and volume of the workspace were 53.9 mm and 15.9cm3, respectively. The S. D values determined for length and volume were 7.2 and 6.02, respectively. For the pathway, a high density area was determined via data obtained through cloud position. Conclusion: Dimension of the EET workspace and characters of EET pathway determine robot's requirements to design and develop EET robotic system. This article demonstrates the conceptual design of an EET robot and successfully accomplishes the goal of guidance and aids in assisting the EET procedures. (C) 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.