Robotic Surgical Assistant Rehearsal: Combining 3-Dimensional-Printing Technology With Preoperative Stereotactic Planning for Placement of Stereoencephalography Electrodes

Abstract

BACKGROUND The use of frameless stereotactic robotic technology has rapidly expanded since the Food and Drug Administration's approval of the Robotic Surgical Assistant (ROSA) in 2012. Although the use of the ROSA robot has greatly augmented stereotactic placement of intracerebral stereoelectroencephalography (sEEG) for the purposes of epileptogenic focus identification, the preoperative planning stages remain limited to computer software. OBJECTIVE To describe the use of a 3-dimensionally (3D)-printed patient model in the preoperative planning of ROSA-assisted depth electrode placement for epilepsy monitoring in a pediatric patient. METHODS An anatomically accurate 3D model was created and registered in a preoperative rehearsal session using the ROSA platform. After standard software-based electrode trajectory planning, sEEG electrodes were sequentially placed in the 3D model. RESULTS Utilization of the 3D-printed model enabled workflow optimization and increased staff familiarity with the logistics of the robotic technology as it relates to depth electrode placement. The rehearsal maneuvers enabled optimization of patient head positioning as well as identification of physical conflicts between 2 electrodes. This permitted revision of trajectory planning in anticipation of the actual case, thereby improving patient safety and decreasing operative time. CONCLUSION Use of a 3D-printed patient model enhanced presurgical positioning and trajectory planning in the placement of stereotactic sEEG electrodes for epilepsy monitoring in a pediatric patient. The ROSA rehearsal decreased operative time and increased efficiency of electrode placement.

Frameless stereotactic brain biopsy: A prospective study on robot‐assisted brain biopsies performed on 32 patients by using the RONNA G4 system

“…A detailed overview of the application of the positioning algorithm can be found 27 . This type of function developed for the RONNA G4 system forewarns the medical staff about the situations in which operative trajectories cannot be reached by the robot or are in collision; what can be a problem if the operative plan has a certain overlap between the trajectories 28 . RONNA has a mobile base enabling the neurosurgeon to position the robot such that the operative field is easily accessible to the surgeon and other personnel.…”

“…27 This type of function developed for the RONNA G4 system forewarns the medical staff about the situations in which operative trajectories cannot be reached by the robot or are in collision; what can be a problem if the operative plan has a certain overlap between the trajectories. 28 RONNA has a mobile base enabling the neurosurgeon to position the robot such that the operative field is easily accessible to the surgeon and other personnel. After the robot is manually positioned with respect to the patient the positioning algorithm once more verifies if the position of the robot is adequate and that all operative trajectories are feasible.…”

Vertical Hemispherotomy: Contribution of Advanced Three-Dimensional Modeling for Presurgical Planning and Training

“…For these reasons, advanced software for three-dimensional (3D) rendering and virtual and augmented reality simulators may constitute valuable tools to enhance the qua-lity of both presurgical planning and intraoperative performance. Although there is a growing implementation of systems for advanced neuroimaging rendering in different domains of neurosurgery requiring a high level of safety and accuracy, such as skull-base, endoventricular and infratentorial approaches, vascular neurosurgery, endoscopic endonasal, and stereotactic procedures, the application of such technology to epilepsy surgery is less frequently reported in the current literature, especially in the pediatric context [22][23][24][25][26][27][28][29][30][31].…”