Robotics in neurosurgery: Current prevalence and future directions

Abstract

Background: The first instance of a robotic-assisted surgery occurred in neurosurgery; however, it is now more common in other fields such as urology and gynecology. This study aims to characterize the prevalence of robotic surgery among current neurosurgery programs as well as identify trends in clinical trials pertaining to robotic neurosurgery. Methods: Each institution’s website was analyzed for the mention of a robotic neurosurgery program and procedures. The future potential of robotics in neurosurgery was assessed by searching for current clinical trials pertaining to neurosurgical robotic surgery. Results: Of the top 100 programs, 30 offer robotic cranial and 40 offer robotic spinal surgery. No significant differences were observed with robotic surgical offerings between geographic regions in the US. Larger programs (faculty size 16 or over) had 20 of the 30 robotic cranial programs (66.6%), whereas 21 of the 40 robotic spinal programs (52.5%) were at larger programs. An initial search of clinical trials revealed 223 studies, of which only 13 pertained to robotic neurosurgery. Spinal fixation was the most common intervention (six studies), followed by Deep Brain Stimulation (DBS, two studies), Cochlear implants (two studies), laser ablation (LITT, one study), and endovascular embolization (one study). Most studies had industry sponsors (9/13 studies), while only five studies had hospital sponsors. Conclusion: Robotic neurosurgery is still in its infancy with less than half of the top programs offering robotic procedures. Future directions for robotics in neurosurgery appear to be focused on increased automation of stereotactic procedures such as DBS and LITT and robot-assisted spinal surgery.

Toward Faster Revascularization in Large Vessel Acute Ischemic Stroke: Reducing Door-to-Groin Puncture Times

“…41 Although slow to enter the neurosurgical realm given the complexity of cerebral arteries, there have been some promising advancements in the world of robotic surgery. 43 Many of these techniques remain in the proof-of-concept stage, with trials on real patients still lacking.…”

“…Multiple clinical trials employing this strategy have not shown significant improvement; however, these trials did not use intra-arterial delivery of neuroprotective drugs 41. Although slow to enter the neurosurgical realm given the complexity of cerebral arteries, there have been some promising advancements in the world of robotic surgery 43. Many of these techniques remain in the proof-of-concept stage, with trials on real patients still lacking.…”

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

“…Neurosurgery, as a specialty, faces unique demographic challenges rooted in its relatively small size compared to broader fields like orthopedics and anesthesiology ( Roche et al, 2019 ; Reulen et al, 2009 ; Singh et al, 2022a , Singh et al, 2022b ; Ukachukwu et al, 2022 ). This disparity manifests in a constrained capacity to cultivate and sustain expertise across an expanding range of subspecialties.…”

“…For example, the integration of artificial intelligence and machine learning can revolutionize the way neurosurgeons approach diagnosis, treatment planning, and risk assessment, leading to more personalized and effective care ( Kazemzadeh et al, 2023 ). Additionally, the development of innovative technologies, such as brain-computer interfaces and advanced neuroprosthetics, opens new avenues for treating neurological disorders that were previously deemed intractable, thus broadening the scope of neurosurgical intervention ( Singh et al, 2022a , Singh et al, 2022b ; Young et al, 2021 ). Embracing these opportunities requires a strategic approach, including the adoption of interdisciplinary collaboration and the pursuit of targeted research initiatives to explore the full potential of technological innovations in neurosurgery.…”

Advances in artificial intelligence, robotics, augmented and virtual reality in neurosurgery

“…Almost 30 per 100 neurosurgical departments use robotic cranial methods and 40 per 100 departments use robotic spinal methods. While examining the possible application of robotic systems in neurosurgery, 13 clinical trials seemed to be applicable, and none of them were completed ( 47 ). Various indications for robotic usage during neurosurgery are identified.…”