机器人系统在神经耳科手术中的演变与应用：范围综述

文献信息

中文摘要

目的： 梳理机器人系统在神经耳科及侧颅底手术中的技术演变与临床可行性，识别限制其广泛临床转化的瓶颈。
检索数据库： 在Embase、Scopus、PubMed/MEDLINE、Web of Science和Cochrane对照试验中心注册库中进行了系统检索。
综述方法： 按照系统综述和荟萃分析首选报告条目扩展版范围综述（PRISMA-ScR）规范开展范围综述。纳入标准为经同行评议的英文原创研究，评估机器人系统在接受神经耳科手术的人类受试者或尸体模型中的可行性、准确性和临床表现。提取研究特征、空间精度、系统运动学及安全性结局相关数据进行定性综合。
结果： 共57项研究符合纳入标准。值得注意的是，所获文献偏向耳科应用，而非更广泛的侧颅底切除术。出现了两种主要临床应用：影像引导骨磨削（例如直接耳蜗入路）和机器人辅助显微器械操作（例如人工耳蜗电极植入）。机器人磨削系统通过整合多层安全架构（包括力-扭矩传感和持续肌电图监测），始终达到亚毫米级精度（面神经隐窝处常<0.15 mm）。对于电极植入，电动驱动标准化了超慢速度（0.1至0.25 mm/s），与手动技术相比显著减少了阶内移位和最大插入力。广泛采用的主要障碍包括手术准备时间延长、依赖有创基准点配准以及缺乏高保真主动触觉反馈。
结论： 神经耳科中的机器人系统成功减轻了人体生理性震颤并执行严格的运动学安全边界，使先进的微创入路成为可能。广泛的临床整合将取决于向无标记配准的过渡、体内动态模型的验证以及克服经济和流程障碍。

英文摘要

OBJECTIVE: To map the technological evolution and clinical feasibility of robotic systems in neurotologic and lateral skull-base surgery, identifying bottlenecks limiting widespread clinical translation.
DATABASES REVIEWED: A systematic search was conducted across Embase, Scopus, PubMed/MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials.
REVIEW METHODS: A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews-compliant scoping review was conducted. Inclusion criteria comprised peer-reviewed, English-language original research evaluating the feasibility, accuracy, and clinical performance of robotic systems in human subjects or cadaveric models undergoing neurotologic procedures. Data regarding study characteristics, spatial accuracy, system kinematics, and safety outcomes were extracted for qualitative synthesis.
RESULTS: Fifty-seven studies met the inclusion criteria. Notably, the yielded literature was skewed toward otologic applications rather than broader lateral skull-base resections. Two dominant clinical applications emerged: image-guided bone milling (eg, direct cochlear access) and robotic-assisted microinstrumentation (eg, cochlear implant electrode insertion). Robotic milling systems consistently achieved submillimetric accuracy (frequently <0.15 mm at the facial recess) by integrating multilayer safety architectures, including force-torque sensing and continuous electromyography. For electrode insertion, motorized actuation standardized ultra-slow velocities (0.1 to 0.25 mm/s), significantly reducing scalar translocations and maximum insertion forces compared with manual techniques. Primary barriers to broad adoption include prolonged operative setup times, reliance on invasive fiducial registration, and an absence of high-fidelity active haptic feedback.
CONCLUSION: Robotic systems in neurotology successfully mitigate physiological human tremor and enforce strict kinematic safety boundaries, enabling advanced, minimally invasive approaches. Widespread clinical integration will depend on transitioning to markerless registration, validating in vivo dynamic models, and overcoming economic and workflow barriers.