Luo Z, Li C, Du X, Wang T. Robot-assistant visualized minimally invasive aspiration (RAVMIA) technique for intracerebral hemorrhage evacuation: Case series.
Heliyon 2024;
10:e39803. [PMID:
39524743 PMCID:
PMC11544056 DOI:
10.1016/j.heliyon.2024.e39803]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 10/19/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
Background and Importance
The surgical management of intracerebral hemorrhage (ICH) remains controversial due to unfavorable outcomes reported in several influential clinical trials. There is a pressing need for novel instrumentation and approaches that optimize evacuation efficiency while minimizing invasiveness. Among the emerging techniques, endoscopic surgery and robot-assisted minimally invasive catheterization (robotic MISTIE) show potential. However, the former still results in brain damage at a centimeter level, while the latter exhibits low evacuation efficiency due to its non-visualized nature.
Methods
We have developed a novel technique called robot-assisted visualized minimally invasive aspiration (RAVMIA) for the evacuation of ICH. This technique integrates neurosurgical robot navigation, contact-visible endoscopy, and minimally invasive catheterization. The efficacy of RAVMIA was evaluated using robotic MISTIE as a historical control.
Results
The RAVMIA technique was successfully implemented in three cases of ICH without complications. Brain damage was limited to 5mm. Compared to robotic MISTIE, RAVMIA did not prolong operative time (20.67 ± 4.04 minutes vs. 20.87 ± 5.74 minutes, p = 0.946) but significantly increased the intraoperative hematoma evacuation rate from 80.8 ± 4.1 % to 86.6 ± 1.3 % (p = 0.003). Consequently, the end-of-treatment residual ICH volume decreased from 5.3 ± 2.95 ml to 1.3 ± 1.05 ml (p = 0.004), and the hospital stay was reduced from 12.87 ± 4.55 days to 10.67 ± 4.04 days (p = 0.029).
Conclusion
The preliminary application of the RAVMIA technique demonstrates its safety and feasibility in treating long, oval-shaped basal ganglia hematoma and brain stem hematoma. This method achieves high evacuation efficiency while minimizing invasiveness. Further technical optimization and clinical trials are warranted to fully explore its potential.
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