Background: Continuous precise motions are required in microneurosurgery to provide high-quality surgical results. Stabilizing the surgeon's arm and reducing fatigue during surgery are expected to improve the precision of microsurgical procedures. We have developed an intelligent armrest, EXPERT, that follows the surgeon's hand and fixes at an adequate position automatically using robotics technology. Objective: To understand the feasibility of EXPERT by using the system in laboratory experiments and clinical situations. Methods: EXPERT has an arm holder and acts as a passive controlled robot with 5 degrees of freedom. The system has 3 modes: transfer, arm-holding, and arm-free mode, which are selected automatically. In the transfer mode, the arm holder follows the surgeon's arm. In the arm-holding mode, EXPERT supports the surgeon's arm weight by fixing the arm holder. The surgeon can move his/her arm away from the arm holder in the arm-free mode. The surgeon can change the position of armrest while looking through the microscope and can continue the microsurgical procedure while holding surgical instruments. Since 2010, EXPERT has been applied in 13 surgeries. Results: The EXPERT system decreased surgeon fatigue and reduced difficulty in performing surgical procedures. The EXPERT system markedly reduced surgeon hand tremor. There were no complications related to the use of this system. Conclusion: EXPERT is a useful tool for holding the surgeon's arm comfortably and following the surgeon's arm automatically.
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