Robotic Neurological Surgery Applications: Accuracy and Consistency or Pure Fantasy?

Abstract

Introduction: Minimally invasive surgery was born out of recent advances in neuroimaging and stereotaxy, and the scale of future neurosurgical procedures will soon be so small that it will not be possible for the unassisted surgeons. Hence, neurosurgical robotics is a natural evolution in this field. The aim of this study was to evaluate the performance of a new robotic system in a wide range of neurosurgical applications. Methods: Patients undergoing image-guided surgical procedures were recruited to participate in this prospective ethically approved study from 2005. The PathFinder (Prosurgics, UK) is a neurosurgical robotic system with 6 degrees of freedom. It uses a fiducial system that is automatically detectable by the planning software and a camera system embedded in the robot’s head. The registration procedure was performed automatically by photographing the fiducials from different angles. The robot then aligns its end-effector and tool holder along the specified path for the surgeon to pass the probe to the target. We recruited 37 consecutive patients to test the application accuracy and consistency of the system using three different fiducial fixation mechanisms: a double adhesive fixed to the skin, an ECG lead dot fixed to the skin, and a registration plate fixed to the skull. Results: Out of 37 consecutive patients, 17 were males and 20 were females, with a mean age of 46.6 years. The procedures were: transsphenoidal in 8, malignant tumour biopsies in 3 and resections in 5, benign tumour excisions in 6 and functional procedures in 15 [6 bilateral deep-brain stimulations (DBSs) of the subthalamic nucleus for Parkinson’s disease, 3 bilateral anterior cingulotomies for depression, 3 bilateral DBSs of the ventral intermediate nucleus of the thalamus for tremor and 3 depth electrodes during epilepsy surgery]. We tested a total of 140 targets with an average of 3–4 targets per patient. The mean application accuracy was less than 1 mm and the application accuracy was consistent in all targets in the same patient. Conclusions: This robotic system was very accurate and consistent in practice as long as the robot had achieved acceptable registration.

The Impact of the Reference Imaging Modality, Registration Method and Intraoperative Flat-Panel Computed Tomography on the Accuracy of the ROSA® Stereotactic Robot

“…For the STN-DBS patients, the mean preoperative L -dopa response was 52.55% and the mean L -dopa response status was 14.25 [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. The mean UPDRS III improvement at 6 months was 75% (mean ‘off med' score before surgery = 30.8 [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], mean score ‘on stim/on med' = 7.8 [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17], mean ‘on stim/off med' score after 6 months = 14.15 [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]). There was neither mortality nor morbidity (permanent nor transient) related to the DBS surgeries.…”

“…The accuracy of stereotactic procedures has been extensively studied [2,3,4,5,6,7,8,9,10,11,12]. However, technology is evolving rapidly in terms of both the surgical equipment and imaging techniques.…”

“…It is known that the imaging and registration modalities have a major influence on the accuracy of stereotactic procedures [13]. The impact of robotic techniques on accuracy in stereotactic surgery is subject to debate, with greater ease of use rather than greater accuracy [3,12,14]. ROSA® is a new robotic arm with 6 degrees of freedom.…”

Evaluation of a neurosurgical robotic system to make accurate burr holes

“…In real life, a similar fiducials system attached to the skin will not necessarily replicate these accuracies. The senior author reported a median application accuracy of better than 1 mm in 140 clinical targets in a wide range of clinical applications using the same fiducial system attached to the skin (14). To replicate the accuracies reported in this study, it would be necessary to use bone anchored RF systems.…”

Virtual Interactive Presence in Global Surgical Education: International Collaboration Through Augmented Reality

“…Additionally, most neurosurgical procedures are not amenable to existing robotic technology, and the cost of complex systems has limited the role of robotic tools in neurosurgery. (20,41)…”