Safety and feasibility of a dexterity-enhancing handheld robot for endoscopic neurosurgery: an in-vivo animal study (IDEAL stage 0)

Minimally invasive neurosurgery is limited by narrow corridors and restricted instrument dexterity. To overcome these challenges, we developed a handheld robotic system to enhance surgical performance. This preclinical in vivo study (IDEAL Stage 0) presents the first evaluation of the system across three neurosurgical approaches - subfrontal, transparietal, and supracerebellar in two ovine models. Three robotic end-effectors (dissector, forceps, curette) were assessed for safety and feasibility. Safety was confirmed via intraoperative monitoring and necropsy, with no device-related morbidity, mortality, or adverse events. All predefined tasks were feasible; the percentage of tasks rated “very easy” or “easy” was 81% (dissector), 96% (forceps), and 100% (curette). Surgeons reported high usability, suggesting refinements related to instrument sharpness and retraction force. These results support the safety and feasibility of the system and highlight its potential to improve surgical precision while preserving surgeon autonomy. The findings justify further refinement and progression to early human studies.