Robotic-like maneuverability in endoscopic endonasal surgery: clinical experience with manually operated steerable forceps.
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Steerable-tip forceps with robotic-like articulation have recently been introduced in endoscopic endonasal surgery to enhance maneuverability in narrow and deep surgical fields. Although manually controlled, these instruments reproduce the multi-degree freedom of robotic forceps. To evaluate their clinical utility and potential relevance as a transitional step toward robotic integration in neurosurgery, we retrospectively reviewed 402 cases of endoscopic endonasal surgery in which steerable-tip forceps were available. Surgical records and videos were analyzed to determine utilization, enabled techniques, effectiveness, adverse events, and resection rates in cases aimed at complete lesion removal. Effectiveness was classified as completely useful, partially useful, or not useful. The forceps were applied in 330 cases, with 203 (61.5%) deemed completely useful, 45 (13.6%) partially useful, and 82 (24.8%) not useful. No adverse events were directly attributable to the instrument. The device facilitated robotic-like techniques such as multidirectional tumor traction, dynamic blunt dissection with tip articulation, and precise positioning of pedicled mucosal flaps, even in peripheral surgical sites. In cases where the forceps were completely useful, the gross total resection rate was 62.5% (115/184), which was significantly higher than in cases where they were only partially or not useful (62.5% vs. 40%, P = 0.0005). These findings suggest that manually controlled steerable-tip forceps can substantially improve maneuverability and access during endoscopic endonasal surgery. By reproducing key functional advantages of robotic instrumentation, these devices provide important translational insights and establish a foundation for the future development and application of robotics in neurosurgery.