Evaluation of robotic assistance in neurosurgical applications

Stereotactic Neuro-Navigation Phantom Designs: A Systematic Review

Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000–2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.

Feasibility of Shape Memory Alloy Wire Actuation for an Active Steerable Cannula

Needle insertion is used in many diagnostic and therapeutic percutaneous medical procedures such as brachytherapy, thermal ablations, and breast biopsy. Insufficient accuracy using conventional surgical cannulas motivated researchers to provide actuation forces to the cannula's body for compensating the possible errors of surgeons/physicians. In this study, we present the feasibility of using shape memory alloy (SMA) wires as actuators for an active steerable surgical cannula. A three-dimensional (3D) finite element (FE) model of the active steerable cannula was developed to demonstrate the feasibility of using SMA wires as actuators to bend the surgical cannula. The material characteristics of SMAs were simulated by defining multilinear elastic isothermal stress–strain curves that were generated through a matlab code based on the Brinson model. Rigorous experiments with SMA wires were done to determine the material properties as well as to show the capability of the code to predict a stabilized SMA transformation behavior with sufficient accuracy. In the FE simulation, birth and death method was used to achieve the prestrain condition on SMA wire prior to actuation. This numerical simulation was validated with cannula deflection experiments with developed prototypes of the active cannula. Several design parameters affecting the cannula's deflection such as the cannula's Young's modulus, the SMA's prestrain, and its offset from the neutral axis of the cannula were studied using the FE model. Real-time experiments with different prototypes showed that the quickest response and the maximum deflection were achieved by the cannula with two sections of actuation compared to a single section of actuation. The numerical and experimental studies showed that a highly maneuverable active cannulas can be achieved using the actuation of multiple SMA wires in series.

Current Capabilities and Development Potential in Surgical Robotics

Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to assess their maturity from the commercialization point of view.

Technical accuracy of optical and the electromagnetic tracking systems

Thousands of operations are annually guided with computer assisted surgery (CAS) technologies. As the use of these devices is rapidly increasing, the reliability of the devices becomes ever more critical. The problem of accuracy assessment of the devices has thus become relevant. During the past five years, over 200 hazardous situations have been documented in the MAUDE database during operations using these devices in the field of neurosurgery alone. Had the accuracy of these devices been periodically assessed pre-operatively, many of them might have been prevented.

The technical accuracy of a commercial navigator enabling the use of both optical (OTS) and electromagnetic (EMTS) tracking systems was assessed in the hospital setting using accuracy assessment tools and methods developed by the authors of this paper. The technical accuracy was obtained by comparing the positions of the navigated tool tip with the phantom accuracy assessment points. Each assessment contained a total of 51 points and a region of surgical interest (ROSI) volume of 120x120x100 mm roughly mimicking the size of the human head.

The error analysis provided a comprehensive understanding of the trend of accuracy of the surgical navigator modalities. This study showed that the technical accuracies of OTS and EMTS over the pre-determined ROSI were nearly equal. However, the placement of the particular modality hardware needs to be optimized for the surgical procedure. New applications of EMTS, which does not require rigid immobilization of the surgical area, are suggested.