We describe the development and approach to clinical application of the neurosurgical robot Minerva, including the mechanical structure of the robot and the software developed to perform intracranial neurosurgical operations with accuracy, smoothness, and safety. The first eight operations have been undertaken on patients requiring stereotactic brain biopsy. We describe the ongoing developments, including improved sterilization features, force sensors, nonlinear electrostimulation probe, and implantation of living encapsulated cells, all of which have entered a test phase. The goals are increased safety and capability to perform simple three‐dimensional operations. This research should ease the way for new complex operations that are difficult to perform manually today. J Image Guid Surg 1:266–272 (1995) © 1996 Wiley‐Liss, Inc.
At the 1989 meeting of the World Society for Stereotactic and Functional Neurosurgery in Maebashi, the authors presented the concept and design of a stereotactic neurosurgical robot. The first prototype has now been completed and has entered clinical testing. The characteristics are as follows. The robot is positioned behind the CT scan and operates inside the CT gantry. It is linked to the CT table and moves freely along its longitudinal axis, allowing for intraoperative scanning at any cranial level. The patient''s body rests on the CT table, but the stereotactic headframe is fixed to the robot, allowing precise measurements of the head position under stereotactic conditions. During scanning, each CT slice appears immediately on the robotic workstation for selection of target and trajectory. In addition to the tool for automatic penetration of the skin, skull, and meninges, the robot is able to handle two other stereotactic instruments and to perform a complete stereotactic procedure without physical intervention by the physician. So far, depth electrodes and biopsy instruments have been developed for use by the robot. Since all parts of the robot were designed solely for stereotactic neurosurgery, integration of safety aspects was optimized. The first operations using an aspiration biopsy probe were successfully performed on 2 patients with malignant intracerebral cystic lesions on September 4, 1993.
We have developed a surgical setup based on modern frameless stereotactic techniques that enables surgeons to visualize the field of view of the surgical endoscope, overlaid with the real-time and volumetrically reconstructed medical images, of a localized area of the patient's anatomy. Using this navigation system, the surgeon visualizes the surgical site via the surgical endoscope, while exploring the inner layers of the patient's anatomy by utilizing the three-dimensionally reconstructed image updates obtained by pre-operative images, such as Magnetic Resonance and/or Computed Tomography Imaging. This system also allows the surgeon to virtually "fly through and around" the site of the surgery to visualize several alternatives and qualitatively determine the best surgical approach. Moving endoscopes are tracked with infra-red stereovision cameras and diodes, allowing the determination of their spatial relation to the target lesion and the fiducial based patient/image registration.
We describe the development and approach to clinical application of the neurosurgical robot Minerva, including the mechanical structure of the robot and the software developed to perform intracranial neurosurgical operations with accuracy, smoothness, and safety. The first eight operations have been undertaken on patients requiring stereotactic brain biopsy. We describe the ongoing developments, including improved sterilization features, force sensors, nonlinear electrostimulation probe, and implantation of living encapsulated cells, all of which have entered a test phase. The goals are increased safety and capability to perform simple three-dimensional operations.
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