Robotics in neurosurgery: state of the art and future technological challenges

Abstract

The use of robotic technologies to assist surgeons was conceptually described almost thirty years ago but has only recently become feasible. In Neurosurgery, medical robots have been applied to neurosurgery for over 19 years. Nevertheless this field remains unknown to most neurosurgeons. The intrinsic characteristics of robots, such as high precision, repeatability and endurance make them ideal surgeon's assistants. Unfortunately, limitations in the current available systems make its use limited to very few centers in the world. During the last decade, important efforts have been made between academic and industry partnerships to develop robots suitable for use in the operating room environment. Although some applications have been successful in areas of laparoscopic surgery and orthopaedics, Neurosurgery has presented a major challenge due to the eloquence of the surrounding anatomy. This review focuses on the application of medical robotics in neurosurgery. The paper begins with an overview of the development of the medical robotics, followed by the current clinical applications in neurosurgery and an analysis of current limitations. We discuss robotic applications based in our own experience in the field. Next, we discuss the technological challenges and research areas to overcome those limitations, including some of our current research approaches for future progress in the field.

Evaluation of a neurosurgical robotic system to make accurate burr holes

“…Despite all the aforementioned advantages of robotics, since it was first used in neurosurgery in 1985 (4,6), the evolution of neurosurgical robotics has been a slow process because they were designed to interact with surgeons and perform or assist in procedures on live patients, and thus are subject to very rigorous health and safety regulations. This study explored the use of robotic systems as a tool-holding device for surgical drills.…”

“…It would be of interest if this finding could be translated into other image guided systems that use different matching algorithms and different methods of registration. Neurosurgery is a key area for the application of robotics for the following reasons: of all the organs the brain requires the highest degree of surgical precision as the slightest deviation of surgical tools can produce severe complications (4). Hence the precise placement of burr holes is very critical in all neurosurgical operations to avoid damage to venous sinuses, particularly with retrosigmoid craniotomy, where the burr has to be made precisely at the junction of the sigmoid and transverse sinuses, or in craniotomies close to or across the midline, where the burr holes are made very close to the superior sagittal sinus.…”

The analysis of intraoperative neurosurgical instrument movement using a navigation log-file

“…In neurosurgery, medical robot technology is still in its infancy, and a lot of mechanical, software and user interface challenges have to be dealt with before this kind of technology is fully beneficial to the treatment of a patient (12,(15)(16)(17).…”

Mechanical analysis of end‐to‐end silk‐sutured anastomosis for robot‐assisted surgery

“…It aims to provide surgeons with tools that enhance and complement their free-hand abilities during surgery. It can not only extend the ability of the surgeon but also enhance the quality of the surgery (1)(2)(3)(4). The superiority of robot-assisted surgery lies in the precision and accuracy of surgery by scaling down motion and filtering out hand tremor, and especially the ability to use copious, detailed and diverse information.…”