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Robotics is routinely used in several surgical fields. Different robots have been applied in neurosurgery, but only a few of them are relevant to neuroendoscopy. This chapter provides an overview of robotics applied to the different fields of cranial neuroendoscopy. It describes the advantages and disadvantages of reported preclinical prototypes and reviews the few clinical studies that have described robotics as applied to neuroendoscopic cranial surgery. Robotics in neurosurgical practice is a growing field of interest. As it stands, more research is needed to develop systems that are conceived specifically for cranial neuroendoscopy. Further preclinical and clinical studies are required to evaluate the benefits and limits of current commercially available systems.

Background: A robotic endoscope holder should theoretically provide various advantages in transnasal endoscopic skull base surgery, but only recently has a robotic system become commercially available. The objective of this study was to provide a preclinical evaluation of potential advantages and surgeon first impression of this robotic hybrid solution. Methods: Thirty skull base surgeons, attending the Joint European Diploma of Endoscopic Skull Base Surgery 2018–2019 in Paris, France, were enrolled. A questionnaire, mainly concerning personal surgical experience and habits, was administered. The test phase consisted of 2 different dry-lab tasks, performed with and without EndoscopeRobot, according to randomization and on 2 different days. A modified NASA Task Load Index test was subsequently administered via e-mail to all participants. Completion times and modified Global Evaluative Assessment of Robotic Skills in Endoscopy scores of the videotaped tasks were recorded. Results: Nineteen otorhinolaryngologic surgeons and 11 neurosurgeons, with different surgical habits and endoscopic experience, were enrolled. No one appeared unfavorable a priori to robotic endoscopic surgery. Although the robot did not provide an advantage in the simple grasping task 1, a trend toward better completion times and efficacy was evident in the bimanual task 2, when performed with the robot and bimanually. According to the modified NASA Task Load Index test, surgeons felt more successful with the robot in task 2, finding it less stressful and mentally demanding. Conclusions: Endoscopic skull base surgeons seem to view a hybrid robotic solution positively. EndoscopeRobot seems to provide a benefit to the single surgeon with experience in bimanual endoscopic surgery. Further preclinical and clinical evaluation of this technology is necessary.

Robotics has already been applied to several surgical fields, but only transoral robotic surgery has a recognized role in skull base surgery. Different preclinical prototypes have been described for endoscopic transnasal skull base surgery (ESBS), but only recently a dedicated, hybrid robotic system has become available for clinical practice.This chapter reviews the use of holders in neurosurgery and skull base surgery, provides an overview of limitations of previous robotic systems that were designed for other surgical applications, describes the different preclinical robotic prototypes that have been developed for ESBS, and reports the initial preclinical and clinical experience with a novel, dedicated, hybrid robotic solution for endoscopic skull base surgery (EndoscopeRobot®, Medineering, Munich, Germany).The era of robotics in skull base surgery is at its dawn, but advantages of the hybrid solution are already evident, though further studies are needed to gain additional data.