Robotics in Neurosurgery: Evolution, Current Challenges, and Compromises

Doulgeris, James; Gonzalez-Blohm, Sabrina A.; Filis, Andreas; Shea, Thomas M.; Aghayev, Kamran; Vrionis, Frank D.

doi:10.1177/107327481502200314

Cited by 66 publications

(35 citation statements)

References 27 publications

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“…For instance, in one study of 112 patients and 536 pedicle screws, the use of the SpineAssist™ surgical robot significantly increased screw accuracy (94.5% vs 91.4%) and decreased radiation exposure (34 s vs 77 s) compared to conventional 2-D fluoroscopy [13]. Our current study corroborate the literature that spinal robots, especially the new ExcelsiusGPS®, improve the accuracy of pedicle screw placement and are clinically safe in patients undergoing instrumented fusion [5,10,11]. Furthermore, our proposed screw reproducibility assessment demonstrates that the ExcelsiusGPS® can be utilized for precise execution of an intended, pre-planned trajectory with minimal deviation.…”

Section: Discussionsupporting

confidence: 80%

“…Spinal surgery robots offer several advantages to conventional fluoroscopy-guided or free-hand techniques. In addition to improving screw accuracy, these robots can assist with the development of minimally invasive surgical options and reduce radiation exposure [4,5]. Institutional experiences have been widely reported with the Spine Assist® (Mazor Robotics, Inc., Caesarea, Israel), Mazor Renaissance™ and the ROSA® (Medtech, Montpellier, France) [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Pedicle screw accuracy assessment in ExcelsiusGPS® robotic spine surgery: evaluation of deviation from pre-planned trajectory

et al. 2018

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Background: The ExcelsiusGPS® (Globus Medical, Inc., Audubon, PA) is a next-generation spine surgery robotic system recently approved for use in the United States. The objective of the current study is to assess pedicle screw accuracy and clinical outcomes among two of the first operative cases utilizing the ExcelsiusGPS® robotic system and describe a novel metric to quantify screw deviation. Methods: Two patients who underwent lumbar fusion at a single institution with the ExcelsiusGPS® surgical robot were included. Pre-operative trajectory planning was performed from an intra-operative CT scan using the O-arm (Medtronic, Inc., Minneapolis, MN). After robotic-assisted screw implantation, a post-operative CT scan was obtained to confirm ideal screw placement and accuracy with the planned trajectory. A novel pedicle screw accuracy algorithm was devised to measure screw tip/tail deviation distance and angular offset on axial and sagittal planes. Screw accuracy was concurrently determined by a blinded neuroradiologist using the traditional Gertzbein-Robbins method. Clinical variables such as symptomatology, operative data, and post-operative follow-up were also collected. Results: Eight pedicle screws were placed in two L4-L5 fusion cases. Mean screw tip deviation was 2.1 mm (range 0.8-5.2 mm), mean tail deviation was 3.2 mm (range 0.9-5.4 mm), and mean angular offset was 2.4 degrees (range 0.7-3.8 degrees). All eight screws were accurately placed based on the Gertzbein-Robbins scale (88% Grade A and 12% Grade B). There were no cases of screw revision or new post-operative deficit. Both patients experienced improvement in Frankel grade and Karnofsky Performance Status (KPS) score by 6 weeks post-op. Conclusion: The ExcelsiusGPS® robot allows for precise execution of an intended pre-planned trajectory and accurate screw placement in the first patients to undergo robotic-assisted fusion with this technology.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Pedicle screw accuracy assessment in ExcelsiusGPS® robotic spine surgery: evaluation of deviation from pre-planned trajectory

et al. 2018

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“…The concept of robotics and integration especially has been a recent topic of interest in the surgical realm, with an effort to create more efficient operative platforms. 6,13 The development of surgical robotic devices is founded on the principle of a human-machine interface, which is integral to the definition of a robot. By programming an integrated computer unit, this platform can be referred to as human-computer-machine interface.…”

mentioning

confidence: 99%

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Gonen

Chakravarthi

Monroy-Sosa

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe move toward better, more effective optical visualization in the field of neurosurgery has been a focus of technological innovation. In this study, the authors’ objectives are to describe the feasibility and safety of a new robotic optical platform, namely, the robotically operated video optical telescopic-microscope (ROVOT-m), in cranial microsurgical applications.METHODSA prospective database comprising patients who underwent a cranial procedure between April 2015 and September 2016 was queried, and the first 200 patients who met the inclusion criteria were selected as the cohort for a retrospective chart review. Only adults who underwent microsurgical procedures in which the ROVOT-m was used were considered for the study. Preoperative, intraoperative, and postoperative data were retrieved from electronic medical records. The authors address the feasibility and safety of the ROVOT-m by studying various intraoperative variables and by reporting perioperative morbidity and mortality, respectively. To assess the learning curve, cranial procedures were categorized into 6 progressively increasing complexity groups. The main categories of pathology were I) intracerebral hemorrhages (ICHs); II) intraaxial tumors involving noneloquent regions or noncomplex extraaxial tumors; III) intraaxial tumors involving eloquent regions; IV) skull base pathologies; V) intraventricular lesions; and VI) cerebrovascular lesions. In addition, the entire cohort was evenly divided into early and late cohorts.RESULTSThe patient cohort comprised 104 female (52%) and 96 male (48%) patients with a mean age of 56.7 years. The most common pathological entities encountered were neoplastic lesions (153, 76.5%), followed by ICH (20, 10%). The distribution of cases by complexity categories was 11.5%, 36.5%, 22%, 20%, 3.5%, and 6.5% for Categories I, II, II, IV, V, and VI, respectively. In all 200 cases, the surgical goal was achieved without the need for intraoperative conversion. Overall, the authors encountered 3 (1.5%) major neurological morbidities and 6 (3%) 30-day mortalities. Four of the 6 deaths were in the ICH group, resulting in a 1% mortality rate for the remainder of the cohort when excluding these patients. None of the intraoperative complications were considered to be attributable to the visualization provided by the ROVOT-m. When comparing the early and late cohorts, the authors noticed an increase in the proportion of higher-complexity surgeries (Categories IV–VI), from 23% in the early cohort, to 37% in the late cohort (p = 0.030). In addition, a significant reduction in operating room setup time was demonstrated (p < 0.01).CONCLUSIONSThe feasibility and safety of the ROVOT-m was demonstrated in a wide range of cranial microsurgical applications. The authors report a gradual increase in case complexity over time, representing an incremental acquisition of experience with this technology. A learning curve of both setup and execution phases should be anticipated by new adopters of the robot system. Further prospective studies are required to address the efficacy of ROVOT-m. This system may play a role in neurosurgery as an integrated platform that is applicable to a variety of cranial procedures.

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“…En un sistema tele operado los brazos del robot se convierten en extremidades adicionales del cirujano, por este motivo el especialista debe desarrollar la experticia suficiente y una adecuada propiocepción de sí mismo en conjunto con el robot, para manipular tejidos aún en zonas de baja visibilidad [27]. La habilidad de propiocepción requiere del desarrollo de destrezas especiales y es una de las razones por la cual la curva de aprendizaje se hace extensa [28].…”

Section: Desafios En Robotica Quirurgicaunclassified

Robótica en cirugía y neurocirugía, aplicaciones y desafíos, una revisión

Rosero

Albán

2020

Sci. tech

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La integración de robots en los quirófanos plantea mejorar el desempeño y eficiencia de variados procedimientos, dado que ofrece ventajas destacables sobre los procedimientos convencionales, en particular la precisión, el filtrado de temblor de mano y la posibilidad de ejecución de tareas complejas, sin embargo, aún prevalecen considerables desafíos que afectan la masificación y la maniobrabilidad por parte de los cirujanos. En el presente trabajo se realiza una revisión del estado actual de la cirugía robótica, los retos y las tendencias. En concreto se evidencia la necesidad de mecanismos de realimentación de fuerza óptimos, así como la visualización dinámica mediante realidad aumentada o realidad virtual. Aun no es posible determinar que la cirugía robótica ha alcanzado estándares, sin embargo, la integración de tecnologías alternas permitirá mejorar no solo la eficiencia en cuanto al robot sino respecto de su operación por parte de los cirujanos.

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Robotics in Neurosurgery: Evolution, Current Challenges, and Compromises

Abstract: Robotic-assisted surgery is a promising field in neurosurgery, but improvements and breakthroughs in minimally invasive and endoscopic robotic-assisted surgical systems must occur before robotic assistance becomes commonplace in the neurosurgical field.

Cited by 66 publications

References 27 publications

Pedicle screw accuracy assessment in ExcelsiusGPS® robotic spine surgery: evaluation of deviation from pre-planned trajectory

Pedicle screw accuracy assessment in ExcelsiusGPS® robotic spine surgery: evaluation of deviation from pre-planned trajectory

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Robótica en cirugía y neurocirugía, aplicaciones y desafíos, una revisión

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