Configuration of a Robot Dedicated to Stereotactic Surgery

Glauser, D.; Flury, P.; Durr, Ph.; Funakubo, Hiroyasu; Burckhardt, Christoph B.; Favre, Jacques; Schnyder, Peter; Fankhauser, Heinz

doi:10.1159/000100256

Cited by 28 publications

(6 citation statements)

References 2 publications

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“…Robotics have been successfully used in the Orthopedic and Neurosurgery. [8][9][10] Despite initial success with some early devices, however, there is some concern about the response to automation in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Remote Percutaneous Renal Access Using a New Automated Telesurgical Robotic System

Bauer¹,

Lee²,

Stoianovici³

et al. 2001

Telemedicine Journal and e-Health

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Previous clinical application of remote telesurgery has been the use of a novel system of video teleconferencing equipment along with remote control of a laparoscopic camera at distances over 11,000 miles. Recently, a robotic system has been developed to assist with percutaneous renal surgery. This robot has been incorporated into the telesurgical system to allow remote needle placement into the renal collecting system under radiological guidance. The main component of the telesurgical system is a low degree of freedom robot called "PAKY" (percutaneous access of the kidney). It is custom designed for fluoroscopic guided percutaneous needle insertion into the renal collecting system. The robot is a six-degrees of freedom device. However, when the skin entry site is fixed and held in position, only two degrees of freedom are required to orient the needle in the correct plane for accurate insertion. Remote control of the robot was accomplished over a plain old telephone system (POTS) line. On June 17, 1998, the first remote telerobotic percutaneous renal access procedure was performed between the Johns Hopkins Hospital, Baltimore, Maryland, and Tor Vergata University, Rome, Italy. This new telesurgical robot was successful in term of obtaining percutaneous access within 20 min, with two attempts to obtain entry into the collecting system. This robot represents the first system for performing remote telesurgical interventions in the kidney and demonstrates the feasibility and safety of assisting accurate and rapid needle access to the kidney during percutaneous procedures.

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Section: Discussionmentioning

confidence: 99%

Remote Percutaneous Renal Access Using a New Automated Telesurgical Robotic System

Bauer¹,

Lee²,

Stoianovici³

et al. 2001

Telemedicine Journal and e-Health

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show abstract

“…The list of specifications defines a complex and multilevel strategy for safety of medical robots which has been derived from many sources, including safety strategies in industry, nuclear reactors and civil aviation. Every part of the robot was newly designed and built according to this list of specifications [1][2][3][4]. The concept of a medical robot for direct intervention was validated with the first two operations performed on September 4, 1993, representing a successful attempt to make direct robotic interventions on patients safe and efficient, and to define the condi tions required for efficacy and safety.…”

Section: Discussionmentioning

confidence: 99%

“…The robot was built according to the previously defined list of specifications [1]. Rather than using a modified industrial robot, all parts were newly designed, in order to meet standards of precision compatible with medical use and to satisfy extensive safety requirements.…”

Section: Specifications O F the R O B O Tmentioning

confidence: 99%

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Robot for CT-Guided Stereotactic Neurosurgery

Fankhauser

Glauser²,

Flury³

et al. 1994

Stereotact Funct Neurosurg

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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.

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“…Making operating robots fail-safe requires considerable investment in a ground-up development with redundant critical components, and supervisory monitoring systems. Robots are currently being developed for specific neuro surgical application [20,21]. However, at the present time and for the applications described in this report, a passive robotic articulated arm is simpler to use with less inherent risk.…”

Section: Disadvantages Limitations and Alternativesmentioning

confidence: 99%

Frameless Stereotaxy in Children

et al. 1994

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Frameless stereotaxy provides stereotactic localization without a standard stereotactic frame. Other reference points on the patient are linked to radio-graphic images by means of a three-dimensional (3D) digitizer. We report the use of a frameless stereotactic system to assist in 53 procedures in 52 children using the ISG Viewing Wand system (ISG Technologies, Missasauga, Ont.). This device uses surface landmarks as well as random surface points as the reference system. The three-dimensional digitizer consists of a six-jointed articulated arm to which pointers, a rigid ventriculoscope, or stereotactic biopsy probe guide can be attached. Image reconstruction is performed on standard CT or MRI (3D volume acquisition) images, with typically 3-mm slice thickness. The tip of the probe can be displayed on 3D surfaced objects which can be cut away to reveal reformatted gray scale displayed on the cut surfaces, or in a triorthogonal view where simultaneous reformatted coronal and sagital views at the level of the tip of the probe are displayed. Cases for which the viewing wand was used included craniotomies for tumor (30), vascular malformation (6), epilepsy surgery (5), other lesions (3), rigid ventriculoscopy (9), and stereotactic biopsy (2). The accuracy of the system was measured by placing 20 fiducial markers on a plastic head of which 3-mm thickness CT images had been made. The average error using 4 fiducials as reference points was 1.5 mm when the fiducials were distributed around the circumference of the head. Using random surface points of 10, 20 and 40 in number gave average errors of 2.3, 1.6, 1.5 mm, respectively. Twenty targets were implanted in a cadaver head to which a BRW stereotactic frame (Radionics, Burlington, Mass.) was attached and imaged in the same fashion. The average error of the Viewing Wand, using 20-random surface point registration, was 2.3 mm, compared to 1.8 mm with the BRW frame using the arc system. Frameless stereotaxy is a valuable aid for a variety of neurosurgical procedures in children providing rapid and relatively accurate stereotactic guidance without the hindrance of a stereotactic frame.

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Configuration of a Robot Dedicated to Stereotactic Surgery

Cited by 28 publications

References 2 publications

Remote Percutaneous Renal Access Using a New Automated Telesurgical Robotic System

Remote Percutaneous Renal Access Using a New Automated Telesurgical Robotic System

Robot for CT-Guided Stereotactic Neurosurgery

Frameless Stereotaxy in Children

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