Dual-port robot-assistant visualized minimally invasive aspiration (RAVMIA) for evacuation of irregular basal ganglia hemorrhage: A technical note

The surgical management of intracerebral hemorrhage (ICH) remains controversial. While minimally invasive endoscopic techniques have shown promise, recent trials have not demonstrated positive outcomes for deep-seated basal ganglia hemorrhages. Although we previously reported a novel robot-assisted visualized minimally invasive aspiration (RAVMIA) technique effective for oblong hematomas, irregularly shaped or massive basal ganglia hemorrhages continue to pose a significant clinical challenge.

We applied a dual-port RAVMIA technique in a case of irregular basal ganglia hemorrhage. The hematoma was morphologically deconstructed into two ellipsoids. Using robotic planning, two surgical trajectories were designed along their long axes. Two 5-mm trocars were inserted along these trajectories, and a contact-visible endoscope was used for real-time monitoring of the aspiration process.

The procedure was successfully completed without complications. The total brain parenchymal injury measured 1 cm (comprising two 5-mm tracts). A 92.9% hematoma evacuation rate was achieved within 25 min. Postoperatively, the patient showed improvement in neurological function.

This preliminary technical report demonstrates the potential applicability of the dual-port RAVMIA technique in a single case of irregular basal ganglia hemorrhage. Further studies with larger cohorts are warranted to evaluate its safety, efficacy, and generalizability.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.