Specialised Surgical Instruments for Endoscopic and Endoscope-Assisted Neurosurgery: A Systematic Review of Safety, Efficacy and Usability

SIMPLE SUMMARY: The greatest technical barrier in endoscopic and endoscope-assisted neurosurgery is the instruments employed for these approaches. This systematic review aimed to identify specialised instruments for this type of surgery and evaluate their safety, efficacy and usability. We identified 50 instruments over 60 studies that were broadly safe and effective and generally considered to be ergonomic, though the learning curve was often noted as a disadvantage. Only eight studies compared the new instrument to standard instruments and comparisons were generally favourable to the new instrument. The development of novel and specialised instruments for endoscopic and endoscope-assisted neurosurgery is an area of interest for the field, but these instruments do not meet the need for improved articulation and future development should be based on established guidelines for neurosurgical innovation. ABSTRACT: While there have been great strides in endoscopic and endoscope-assisted neurosurgical approaches, particularly in the treatment of deep-sited brain and skull base tumours, the greatest technical barrier to their adoption has been the availability of suitable surgical instruments. This systematic review seeks to identify specialised instruments for these approaches and evaluate their safety, efficacy and usability. Conducted in accordance with the PRISMA guidelines, Medline, Embase, CENTRAL, SCOPUS and Web of Science were searched. Original research studies that reported the use of specialised mechanical instruments that manipulate tissue in human patients, cadavers or surgical models were included. The results identified 50 specialised instruments over 62 studies. Objective measures of safety were reported in 32 out of 62 studies, and 20 reported objective measures of efficacy. Instruments were broadly safe and effective with one instrument malfunction noted. Measures of usability were reported in 15 studies, with seven reporting on ergonomics and eight on the instruments learning curve. Instruments with reports on usability were generally considered to be ergonomic, though learning curve was often considered a disadvantage. Comparisons to standard instruments were made in eight studies and were generally favourable. While there are many specialised instruments for endoscopic and endoscope-assisted neurosurgery available, the evidence for their safety, efficacy and usability is limited with non-standardised reporting and few comparative studies to standard instruments. Future innovation should be tailored to unmet clinical needs, and evaluation guided by structured development processes.