Review of robotic technology for keyhole transcranial stereotactic neurosurgery

The research of stereotactic apparatus to guide surgical devices began in 1908, yet a major part of today's stereotactic neurosurgeries still rely on stereotactic frames developed almost half a century ago. Robots excel at handling spatial information, and are, thus, obvious candidates in the guidance of instrumentation along precisely planned trajectories. In this review, we introduce the concept of stereotaxy and describe a standard stereotactic neurosurgery. Neurosurgeons' expectations and demands regarding the role of robots as assistive tools are also addressed. We list the most successful robotic systems developed specifically for or capable of executing stereotactic neurosurgery. A critical review is presented for each robotic system, emphasizing the differences between them and detailing positive features and drawbacks. An analysis of the listed robotic system features is also undertaken, in the context of robotic application in stereotactic neurosurgery. Finally, we discuss the current perspective, and future directions of a robotic technology in this field. All robotic systems follow a very similar and structured workflow despite the technical differences that set them apart. No system unequivocally stands out as an absolute best. The trend of technological progress is pointing toward the development of miniaturized cost-effective solutions with more intuitive interfaces.This work has been partially financed by the NETT Project (FP7-PEOPLE-2011-ITN-289146), ACTIVE Project (FP7-ICT-2009-6-270460), and FCT PhD grant (ref. SFRH/BD/86499/2012)

Robotics in neurosurgery: A literature review

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of virtual procedures which turn out to be of great succour for young apprentice surgeons to practise their surgical skills in a safe environment. It also allows senior professionals to rehearse difficult cases before involving into considerable risky procedures

Towards an Implantable Vestibular Prosthesis: The Surgical Challenges

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Computer- and robot-assisted Medical Intervention

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00

Accurate multi-robot targeting for keyhole neurosurgery based on external sensors monitoring

Robotics has recently been introduced in surgery to improve intervention accuracy, to reduce invasiveness and to allow new surgical procedures. In this framework, the ROBOCAST system is an optically surveyed multi-robot chain aimed at enhancing the accuracy of surgical probe insertion during keyhole neurosurgery procedures. The system encompasses three robots, connected as a multiple kinematic chain (serial and parallel), totalling 13 degrees of freedom, and it is used to automatically align the probe onto a desired planned trajectory. The probe is then inserted in the brain, towards the planned target, by means of a haptic interface. This paper presents a new iterative targeting approach to be used in surgical robotic navigation, where the multi-robot chain is used to align the surgical probe to the planned pose, and an external sensor is used to decrease the alignment errors. The iterative targeting was tested in an operating room environment using a skull phantom, and the targets were selected on magnetic resonance images. The proposed targeting procedure allows about 0.3 mm to be obtained as the residual median Euclidean distance between the planned and the desired targets, thus satisfying the surgical accuracy requirements (1 mm), due to the resolution of the diffused medical images. The performances proved to be independent of the robot optical sensor calibration accuracy

Neurosurgery and brain shift: review of the state of the art and main contributions of robotics

Este artículo presenta una revisión acerca de la neurocirugía, los asistentes robóticos en este tipo de procedimiento, y el tratamiento que se le da al problema del desplazamiento que sufre el tejido cerebral, incluyendo las técnicas para la obtención de imágenes médicas. Se abarca de manera especial el fenómeno del desplazamiento cerebral, comúnmente conocido como brain shift, el cual causa pérdida de referencia entre las imágenes preoperatorias y los volúmenes a tratar durante la cirugía guiada por imágenes médicas. Hipotéticamente, con la predicción y corrección del brain shift sobre el sistema de neuronavegación, se podrían planear y seguir trayectorias de mínima invasión, lo que conllevaría a minimizar el daño a los tejidos funcionales y posiblemente a reducir la morbilidad y mortalidad en estos delicados y exigentes procedimientos médicos, como por ejemplo, en la extirpación de un tumor cerebral. Se mencionan también otros inconvenientes asociados a la neurocirugía y se muestra cómo los sistemas robotizados han ayudado a solventar esta problemática. Finalmente se ponen en relieve las perspectivas futuras de esta rama de la medicina, la cual desde muchas disciplinas busca tratar las dolencias del principal órgano del ser humano.This paper presents a review about neurosurgery, robotic assistants in this type of procedure, and the approach to the problem of brain tissue displacement, including techniques for obtaining medical images. It is especially focused on the phenomenon of brain displacement, commonly known as brain shift, which causes a loss of reference between the preoperative images and the volumes to be treated during image-guided surgery. Hypothetically, with brain shift prediction and correction for the neuronavigation system, minimal invasion trajectories could be planned and shortened. This would reduce damage to functional tissues and possibly lower the morbidity and mortality in delicate and demanding medical procedures such as the removal of a brain tumor. This paper also mentions other issues associated with neurosurgery and shows the way robotized systems have helped solve these problems. Finally, it highlights the future perspectives of neurosurgery, a branch of medicine that seeks to treat the ailments of the main organ of the human body from the perspective of many disciplines

Robotic assisted deep brain stimulation neurosurgery: first steps on system development

The advantages of Deep Brain Stimulation (DBS) lead to an increasing number of stereotactic DBS surgeries, which are extensive procedures that require extreme precision and steadiness of tool handling. Robotic manipulators known for their consistency, movement precision and steadiness have the potential to be remarkable tools to assist the neurosurgeons and can refine the quality/working conditions, while improving surgery outcome. Currently, robotic systems for stereotactic neurosurgeries with simple/pragmatic low budget solutions that fulfil the surgeons' needs are not yet available. Thus, we have been asked to develop such robotic system. In this paper we present our first steps toward such endeavour. Specifically, we implemented a simulation environment for robotic assisted DBS neurosurgery that allows emulating several hardware setups within the operating room, and to test and assess their performance. The simulator is useful not only as tool for developing specialized control applications, but also for training clinicians. First results support the viability of the sought solution and open way to future developments.This work has been partially financed by projects FP7 Marie Curie ITN - NETT (project no 289146), FCT FCOMP-01-0124-FEDER-022674 and Pest-C/MATUI0013/2011 (FCT grant ref. UMINHO/BIC/8/2012)