From Rigid to Soft Robotic Approaches for Neuroendoscopy

Robotic assistance has significantly improved the outcomes of open microsurgery and rigid endoscopic surgery; however, is yet to make an impact in flexible endoscopic neurosurgery. Some of the most common intracranial procedures for treatment of hydrocephalus and tumors stand to benefit from increased dexterity and reduced invasiveness offered by robotic navigation in the deep ventricular system of the brain. We review a spectrum of flexible robotic devices, from the traditional highly actuated approach, to more novel and bioinspired mechanisms for safe navigation. For each technology, we identify the operating principle and are able to evaluate the potential for minimally invasive surgical applications. Overall, rigid‐type continuum robots have seen the most development. However, approaches combining rigid and soft robotic principles to exploit internal rather than external interactions for low degree of actuation navigation, are ideally situated to address safety and complexity limitations after future design evolution. We also observe related challenges in the field from surgeon–robot interfaces to robot evaluation procedures. Fundamentally, the challenges revolve around a guarantee of safety in robotic devices, with the prerequisites to assist and improve upon surgical tasks. With innovative designs, materials, and evaluation techniques emerging, we see potential impacts in the next 5–10 years.