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Gunderman AL, Sengupta S, Huang Z, Sigounas D, Oluigbo C, Godage IS, Cleary K, Chen Y. Towards MR-Guided Robotic Intracerebral Hemorrhage Evacuation: Aiming Device Design and ex vivo Ovine Head Trial. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2024; 6:577-588. [PMID: 38911181 PMCID: PMC11189651 DOI: 10.1109/tmrb.2024.3385794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Stereotactic neurosurgery is a well-established surgical technique for navigation and guidance during treatment of intracranial pathologies. Intracerebral hemorrhage (ICH) is an example of various neurosurgical conditions that can benefit from stereotactic neurosurgery. As a part of our ongoing work toward real-time MR-guided ICH evacuation, we aim to address an unmet clinical need for a skull-mounted frameless stereotactic aiming device that can be used with minimally invasive robotic systems for MR-guided interventions. In this paper, we present NICE-Aiming, a Neurosurgical, Interventional, Configurable device for Effective-Aiming in MR-guided robotic neurosurgical interventions. A kinematic model was developed and the system was used with a concentric tube robot (CTR) for ICH evacuation in (i) a skull phantom and (ii) in the first ever reported ex vivo CTR ICH evacuation using an ex vivo ovine head. The NICE-Aiming prototype provided a tip accuracy of 1.41±0.35 mm in free-space. In the MR-guided gel phantom experiment, the targeting accuracy was 2.07±0.42 mm and the residual hematoma volume was 12.87 mL (24.32% of the original volume). In the MR-guided ex vivo ovine head experiment, the targeting accuracy was 2.48±0.48 mm and the residual hematoma volume was 1.42 mL (25.08% of the original volume).
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Affiliation(s)
- Anthony L Gunderman
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30338 USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Zhefeng Huang
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30338 USA
| | - Dimitri Sigounas
- The George Washington University School of Medicine and Health Sciences, Department of Neurosurgery, The George Washington University, Washington, DC, US
| | - Chima Oluigbo
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC 20010 USA
| | - Isuru S Godage
- Department of Engineering Technology and Industrial Distribution, Texas A&M University, College Station, TX, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC 20010 USA
| | - Yue Chen
- Biomedical Engineering Department, Georgia Institute of Technology/Emory, Atlanta 30338 USA
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Theiss P, Alaraj A. Commentary: Preclinical Evaluation of a Novel Steerable Robotic Neuroendoscope Tool. Oper Neurosurg (Hagerstown) 2024; 26:396-397. [PMID: 38038442 DOI: 10.1227/ons.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Peter Theiss
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
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Leclerc A, Deboeuf L, Elia A, Aboubakr O, Planet M, Bedioui A, Rault F, Faisant M, Roux A, Simboli GA, Moiraghi A, Gaberel T, Pallud J, Emery E, Zanello M. Safety and efficacy of frameless stereotactic robot-assisted intraparenchymal brain lesion biopsies versus image-guided biopsies: a bicentric comparative study. Acta Neurochir (Wien) 2024; 166:67. [PMID: 38319393 DOI: 10.1007/s00701-024-05912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE User-friendly robotic assistance and image-guided tools have been developed in the past decades for intraparenchymal brain lesion biopsy. These two methods are gradually becoming well accepted and are performed at the discretion of the neurosurgical teams. However, only a few data comparing their effectiveness and safety are available. METHODS Population-based parallel cohorts were followed from two French university hospitals with different surgical methods and defined geographical catchment regions (September 2019 to September 2022). In center A, frameless robot-assisted stereotactic intraparenchymal brain lesion biopsies were performed, while image-guided intraparenchymal brain lesion biopsies were performed in center B. Pre-and postoperative clinical, radiological, and histomolecular features were retrospectively collected and compared. RESULTS Two hundred fifty patients were included: 131 frameless robot-assisted stereotactic intraparenchymal brain lesion biopsies in center A and 119 image-guided biopsies in center B. The clinical, radiological, and histomolecular features were comparable between the two groups. The diagnostic yield (96.2% and 95.8% respectively; p = 1.000) and the overall postoperative complications rates (13% and 14%, respectively; p = 0.880) did not differ between the two groups. The mean duration of the surgical procedure was longer in the robot-assisted group (61.9 ± 25.3 min, range 23-150) than in the image-guided group (47.4 ± 11.8 min, range 25-81, p < 0.001). In the subgroup of patients with anticoagulant and/or antiplatelet therapy administered preoperatively, the intracerebral hemorrhage > 10 mm on postoperative CT scan was higher in the image-guided group (36.8%) than in the robot-assisted group (5%, p < 0.001). CONCLUSION In our bicentric comparative study, robot-assisted stereotactic and image-guided biopsies have two main differences (shorter time but more frequent postoperative hematoma for image-guided biopsies); however, both techniques are demonstrated to be safe and efficient.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, ISTCT/CERVOxy Group, UMR6030, GIP CYCERON, Normandy University, Caen, France
| | - Louise Deboeuf
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Angela Elia
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Oumaima Aboubakr
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Martin Planet
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Aziz Bedioui
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Fréderick Rault
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Maxime Faisant
- Department of Anatomopathology, Caen University Hospital, Caen, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Giorgia Antonia Simboli
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Alessandro Moiraghi
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Normandie University, Cyceron, Caen, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Normandie University, Cyceron, Caen, France
| | - Marc Zanello
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France.
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France.
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Zhou S, Gao Y, Li R, Wang H, Zhang M, Guo Y, Cui W, Brown KG, Han C, Shi L, Liu H, Zhang J, Li Y, Meng F. Neurosurgical robots in China: State of the art and future prospect. iScience 2023; 26:107983. [PMID: 37867956 PMCID: PMC10589856 DOI: 10.1016/j.isci.2023.107983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Neurosurgical robots have developed for decades and can effectively assist surgeons to carry out a variety of surgical operations, such as biopsy, stereo-electroencephalography (SEEG), deep brain stimulation (DBS), and so forth. In recent years, neurosurgical robots in China have developed rapidly. This article will focus on several key skills in neurosurgical robots, such as medical imaging systems, automatic manipulator, lesion localization techniques, multimodal image fusion technology, registration method, and vascular imaging technology; introduce the clinical application of neurosurgical robots in China, and look forward to the potential improvement points in the future based on our experience and research in the field.
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Affiliation(s)
- Siyu Zhou
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Yuan Gao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Renpeng Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Huizhi Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Moxuan Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Yuzhu Guo
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Weigang Cui
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Kayla Giovanna Brown
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Chunlei Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Huanguang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Yang Li
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
- Chinese Institute for Brain Research, Beijing 102206, China
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5
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Park C, Shabani S, Agarwal N, Tan L, Mummaneni PV. Robotic-Assisted Surgery and Navigation in Deformity Surgery. Neurosurg Clin N Am 2023; 34:659-664. [PMID: 37718112 DOI: 10.1016/j.nec.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Deformity surgery is advancing quickly with the use of three-dimensional navigation and robotics. In spinal fusion, the use of robotics improves screw placement accuracy and reduces radiation, complications, blood loss, and recovery time. Currently, there is limited evidence showing that robotics is better than traditional freehand techniques. Most studies favoring robotics are small and retrospective due to the novelty of the technology in deformity surgery. Using these systems can also be expensive and time-consuming. Surgeons should use these advancements as tools, but not rely on them to replace surgical experience, anatomy knowledge, and good judgment.
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Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Saman Shabani
- Department of Neurological Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lee Tan
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Wu Z, Chen D, Pan C, Zhang G, Chen S, Shi J, Meng C, Zhao X, Tao B, Chen D, Liu W, Ding H, Tang Z. Surgical Robotics for Intracerebral Hemorrhage Treatment: State of the Art and Future Directions. Ann Biomed Eng 2023; 51:1933-1941. [PMID: 37405558 PMCID: PMC10409846 DOI: 10.1007/s10439-023-03295-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023]
Abstract
Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and disability, and there are no proven medical treatments that can improve the functional outcome of ICH patients. Robot-assisted neurosurgery is a significant advancement in the development of minimally invasive surgery for ICH. This review encompasses the latest advances and future directions of surgical robots for ICH. First, three robotic systems for neurosurgery applied to ICH are illustrated. Second, the key technologies of robot-assisted surgery for ICH are introduced in aspects of stereotactic technique and navigation, the puncture instrument, and hematoma evacuation. Finally, the limitations of current surgical robots are summarized, and the possible development direction is discussed, which is named "multisensor fusion and intelligent aspiration control of minimally invasive surgical robot for ICH". It is expected that the new generation of surgical robots for ICH will facilitate quantitative, precise, individualized, standardized treatment strategies for ICH.
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Affiliation(s)
- Zhuojin Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ge Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian Shi
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Cai Meng
- School of Mechanical Engineering & Automation-BUAA, Beihang University, Beijing, 100083, China
| | - Xingwei Zhao
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Bo Tao
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Diansheng Chen
- School of Mechanical Engineering & Automation-BUAA, Beihang University, Beijing, 100083, China
| | - Wenjie Liu
- Beijing WanTeFu Medical Instrument Co., Ltd, Beijing, 102299, China
| | - Han Ding
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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7
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Abougamil A, L Srinivasan H, Fiandeiro CE, D C Kumar R, Bibby S, Booth TC, Hasegawa H, Walsh DC. Robotically facilitated parafasicular microsurgery to a brain arteriovenous malformation in a paediatric patient. Br J Neurosurg 2023:1-7. [PMID: 37652406 DOI: 10.1080/02688697.2023.2239902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 05/26/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE We report what we believe is the first application of robotically constrained image-guided surgery to approach a fistulous micro-arteriovenous malformation in a highly eloquent location. Drawing on institutional experience with a supervisory-control robotic system, a series of steps were devised to deliver a tubular retractor system to a deeply situated micro-arteriovenous malformation. The surgical footprint of this procedure was minimised along with the neurological morbidity. We hope that our contribution will be of assistance to others in integrating such systems given a similar clinical problem. CLINICAL PRESENTATION A right-handed 9-year old girl presented to her local emergency department after a sudden onset of severe headache accompanied by vomiting. An intracranial haemorrhage centred in the right centrum semiovale with intraventricular extension was evident and she was transferred urgently to the regional paediatric neurosurgical centre, where an external ventricular drain (EVD) was sited. A digital subtraction angiogram demonstrated a small right hemispheric arteriovenous shunt irrigated by peripheral branches of the middle cerebral artery & a robotically facilitated parafasicular microsurgical approach was performed to disconnect the arteriovenous malformation. CONCLUSION We describe the successful microsurgical in-situ disconnection of a deeply-situated, fistulous micro-AVM via a port system itself delivered directly to the target with a supervisory-control robotic system. This minimised the surgical disturbance along a relatively long white matter trajectory and demonstrates the feasibility of this approach for deeply located arteriovenous fistulae or fistulous AVMs.
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Affiliation(s)
- Ahmed Abougamil
- Department of Neurovascular Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Harishchandra L Srinivasan
- Department of Epilepsy and Functional Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Carlos E Fiandeiro
- Department of Neuroanaesthesia, King's College Hospital NHS Foundation Trust, London, UK
| | - Robin D C Kumar
- Department of Neuroanaesthesia, King's College Hospital NHS Foundation Trust, London, UK
| | - Steven Bibby
- Department of Interventional Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Thomas C Booth
- Department of Interventional Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Harutomo Hasegawa
- Department of Epilepsy and Functional Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Paediatric Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel C Walsh
- Department of Neurovascular Surgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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8
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Ma FZ, Liu DF, Yang AC, Zhang K, Meng FG, Zhang JG, Liu HG. Application of the robot-assisted implantation in deep brain stimulation. Front Neurorobot 2022; 16:996685. [PMID: 36531913 PMCID: PMC9755501 DOI: 10.3389/fnbot.2022.996685] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/21/2022] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION This work aims to assess the accuracy of robotic assistance guided by a videometric tracker in deep brain stimulation (DBS). METHODS We retrospectively reviewed a total of 30 DBS electrode implantations, assisted by the Remebot robotic system, with a novel frameless videometric registration workflow. Then we selected 30 PD patients who used stereotactic frame surgery to implant electrodes during the same period. For each electrode, accuracy was assessed using radial and axial error. RESULTS The average radial error of the robot-assisted electrode implantation was 1.28 ± 0.36 mm, and the average axial error was 1.20 ± 0.40 mm. No deaths or associated hemorrhages, infections or poor incision healing occurred. CONCLUSION Robot-assisted implantation guided by a videometric tracker is accurate and safe.
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Affiliation(s)
- Fang-Zhou Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - De-Feng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - An-Chao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Fan-Gang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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9
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Secoli R, Matheson E, Pinzi M, Galvan S, Donder A, Watts T, Riva M, Zani DD, Bello L, Rodriguez y Baena F. Modular robotic platform for precision neurosurgery with a bio-inspired needle: System overview and first in-vivo deployment. PLoS One 2022; 17:e0275686. [PMID: 36260553 PMCID: PMC9581417 DOI: 10.1371/journal.pone.0275686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Over the past 10 years, minimally invasive surgery (MIS) has shown significant benefits compared to conventional surgical techniques, with reduced trauma, shorter hospital stays, and shorter patient recovery times. In neurosurgical MIS procedures, inserting a straight tool (e.g. catheter) is common practice in applications ranging from biopsy and laser ablation, to drug delivery and fluid evacuation. How to handle tissue deformation, target migration and access to deep-seated anatomical structures remain an open challenge, affecting both the preoperative planning phase and eventual surgical intervention. Here, we present the first neurosurgical platform in the literature, able to deliver an implantable steerable needle for a range of diagnostic and therapeutic applications, with a short-term focus on localised drug delivery. This work presents the system's architecture and first in vivo deployment with an optimised surgical workflow designed for pre-clinical trials with the ovine model, which demonstrate appropriate function and safe implantation.
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Affiliation(s)
- Riccardo Secoli
- The Mechatronics in Medicine Lab, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
- * E-mail:
| | - Eloise Matheson
- The Mechatronics in Medicine Lab, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Marlene Pinzi
- The Mechatronics in Medicine Lab, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Stefano Galvan
- The Mechatronics in Medicine Lab, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Abdulhamit Donder
- The Mechatronics in Medicine Lab, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Thomas Watts
- The Mechatronics in Medicine Lab, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Marco Riva
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital Rozzano, Rozzano, Italy
| | - Davide Danilo Zani
- Department of Veterinary Medicine, Universitá degli Studi di Milano, Lodi, Italy
| | - Lorenzo Bello
- Department of Oncology and Hematology-Oncology, Universitá degli Studi di Milano, Milan, Italy
| | - Ferdinando Rodriguez y Baena
- The Mechatronics in Medicine Lab, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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Giridharan N, Katlowitz KA, Anand A, Gadot R, Najera RA, Shofty B, Snyder R, Larrinaga C, Prablek M, Karas PJ, Viswanathan A, Sheth SA. Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow. Oper Neurosurg (Hagerstown) 2022; 23:254-260. [PMID: 35972090 DOI: 10.1227/ons.0000000000000298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A number of stereotactic platforms are available for performing deep brain stimulation (DBS) lead implantation. Robot-assisted stereotaxy has emerged more recently demonstrating comparable accuracy and shorter operating room times compared with conventional frame-based systems. OBJECTIVE To compare the accuracy of our streamlined robotic DBS workflow with data in the literature from frame-based and frameless systems. METHODS We retrospectively reviewed 126 consecutive DBS lead placement procedures using a robotic stereotactic platform. Indications included Parkinson disease (n = 94), essential tremor (n = 21), obsessive compulsive disorder (n = 7), and dystonia (n = 4). Procedures were performed using a stereotactic frame for fixation and the frame pins as skull fiducials for robot registration. We used intraoperative fluoroscopic computed tomography for registration and postplacement verification. RESULTS The mean radial error for the target point was 1.06 mm (SD: 0.55 mm, range 0.04-2.80 mm) on intraoperative fluoroscopic computed tomography. The mean operative time for an asleep, bilateral implant without implantable pulse generator placement was 238 minutes (SD: 52 minutes), and skin-to-skin procedure time was 116 minutes (SD: 42 minutes). CONCLUSION We describe a streamlined workflow for DBS lead placement using robot-assisted stereotaxy with a comparable accuracy profile. Obviating the need for checking and switching coordinates, as is standard for frame-based DBS, also reduces the chance for human error and facilitates training.
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Affiliation(s)
- Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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11
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Pilot study of a new type of machine vision-assisted stereotactic neurosurgery for EVD placement. Acta Neurochir (Wien) 2022; 164:2385-2393. [PMID: 35788905 DOI: 10.1007/s00701-022-05287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The usage of machine vision technologies for image-based analysis and inspection is increasing. With the advent of the ability to process high-dimension data instantly, the possibilities of machine vision multiply exponentially. Robots now use this technology to assist in surgery. OBJECTIVE The aim of this study is to explore the efficacy of Surgical Navigation Robot NaoTrac (Brain Navi Biotechnology Co., Ltd.), which utilizes machine vision-inspired technology for patient registration and stereotactic external ventricular drainage (EVD) by the robotic arm. METHODS Preoperative and postoperative computed tomography (CT) scans were acquired for each case. The surgeons planned the targets and trajectories with the preoperative CT images. The postoperative CT images were utilized in the accuracy measurements. RESULTS All 14 cases had cerebrospinal fluid drained through the catheter. The NaoTrac placed the catheter into the frontal horn in one attempt in 13 cases and was able to drain CSF in 12 cases. Not a single case had any bleeding or intraoperative complications. The average time spent on the patient registration was 142.8 s. The mean target deviation was 1.68 mm, and the mean angular deviation was 1.99°, all within the accepted tolerance for minimal tissue damage. CONCLUSION The results of this report demonstrate that machine vision-inspired patient registration is feasible and fast. NaoTrac has demonstrated its accuracy and safety in performing frameless catheter placement in 13 clinical cases. Other stereotactic neurosurgical operations such as stereotactic biopsy, depth electrode placement, deep brain stimulation electrode positioning, and neuroendoscopy may also be benefited from the assistance of NaoTrac.
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12
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Graciolli Cordeiro J, Assumpcao de Monaco B, Theodotou CB, Luther E, Benjamin CG, Jagid JR. Robotic-assisted stereotactic percutaneous balloon compression for trigeminal neuralgia treatment. Clin Neurol Neurosurg 2022; 221:107412. [PMID: 36029611 DOI: 10.1016/j.clineuro.2022.107412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/30/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
Trigeminal neuralgia (TN) is a facial pain disorder that can be a source of significant disability. Percutaneous balloon compression (PBC) has low cost, high efficacy, and minimal invasiveness. Complications can occur due to the balloon inflation or the needle placement itself. In this paper, we describe for the first time the clinical use of robotic-assistance to perform a PBC for TN, presenting our experience in two patients. The stereotactic planning targeted the foramen ovale (FO) establishing a safe and seamless needle trajectory. This yielded a streamlined, single pass needle placement and eliminated the need to "search" for the FO. There were no immediate complications and post-operatively both patients improved their symptoms. Robotic assistance is potentially a useful tool to reduce needle placement related complications, radiation exposure and PBC learning curve.
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Affiliation(s)
| | - Bernardo Assumpcao de Monaco
- Clin. Neurosurgery, University of Miami/Jackson Memorial Hospital, Miami, USA; Functional Neurosurgery, Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | | | - Evan Luther
- Clin. Neurosurgery, University of Miami/Jackson Memorial Hospital, Miami, USA.
| | | | - Jonathan R Jagid
- Clin. Neurosurgery, University of Miami/Jackson Memorial Hospital, Miami, USA.
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13
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. SUMMARY OF BACKGROUND DATA The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. METHODS A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. RESULTS The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. CONCLUSION Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB APPROVAL N/A.
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14
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Baptista TS, Rito M, Chamadoira C, Rocha LF, Evans G, Cunha JPS. Towards a Closed-loop Neuro-Robotic Approach to DBS Electrode Implantation based on Real-Time Wrist Rigidity Evaluation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4830-4833. [PMID: 36086618 DOI: 10.1109/embc48229.2022.9871792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The iHandU system is a wearable device that quantitatively evaluates changes in wrist rigidity during Deep Brain Stimulation (DBS) surgery, allowing clinicians to find optimal stimulation settings that reduce patient symptoms. Robotic accuracy is also especially relevant in DBS surgery, as accurate electrode placement is required to increase effectiveness and reduce side effects. The main goal of this work is to integrate the advantages of each system in a closed-loop system between an industrial robot and the iHandU system. For this purpose, a comparative analysis of a Leksell stereotactic frame and neuro-robotic system accuracies was performed using a lab-made phantom. The neuro-robotic system reached 90% of trajectories, while the stereotactic frame reached all trajectories. There are significant differences in accuracy errors between these trajectories (p < 0.0001), which can be explained by the high correlation between the neuro-robotic system errors and the distance from the trajectory to the origin of the Leksell coordinate system (ρ = 0.72). Overall accuracy is comparable to existing neuro-robotic systems, achieving a deviation of (1.0 ± 0.5) mm at the target point. The accuracy of DBS electrode positioning and stimulation parameters choice leads to better long-term clinical outcomes in Parkinson's disease patients. Our neuro-robotic system combines real-time feedback assessment of the patient's symptomatic response and automatic positioning of the DBS electrode in a specific brain area.
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15
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Jamal A, Yuan T, Galvan S, Castellano A, Riva M, Secoli R, Falini A, Bello L, Rodriguez y Baena F, Dini D. Insights into Infusion-Based Targeted Drug Delivery in the Brain: Perspectives, Challenges and Opportunities. Int J Mol Sci 2022; 23:3139. [PMID: 35328558 PMCID: PMC8949870 DOI: 10.3390/ijms23063139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/31/2023] Open
Abstract
Targeted drug delivery in the brain is instrumental in the treatment of lethal brain diseases, such as glioblastoma multiforme, the most aggressive primary central nervous system tumour in adults. Infusion-based drug delivery techniques, which directly administer to the tissue for local treatment, as in convection-enhanced delivery (CED), provide an important opportunity; however, poor understanding of the pressure-driven drug transport mechanisms in the brain has hindered its ultimate success in clinical applications. In this review, we focus on the biomechanical and biochemical aspects of infusion-based targeted drug delivery in the brain and look into the underlying molecular level mechanisms. We discuss recent advances and challenges in the complementary field of medical robotics and its use in targeted drug delivery in the brain. A critical overview of current research in these areas and their clinical implications is provided. This review delivers new ideas and perspectives for further studies of targeted drug delivery in the brain.
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Affiliation(s)
- Asad Jamal
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK; (T.Y.); (S.G.); (R.S.); (F.R.y.B.)
| | - Tian Yuan
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK; (T.Y.); (S.G.); (R.S.); (F.R.y.B.)
| | - Stefano Galvan
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK; (T.Y.); (S.G.); (R.S.); (F.R.y.B.)
| | - Antonella Castellano
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Marco Riva
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Riccardo Secoli
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK; (T.Y.); (S.G.); (R.S.); (F.R.y.B.)
| | - Andrea Falini
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Lorenzo Bello
- Department of Oncology and Hematology-Oncology, Universitá degli Studi di Milano, 20122 Milan, Italy;
| | - Ferdinando Rodriguez y Baena
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK; (T.Y.); (S.G.); (R.S.); (F.R.y.B.)
| | - Daniele Dini
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK; (T.Y.); (S.G.); (R.S.); (F.R.y.B.)
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16
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Robot-assisted stereotactic multiple brain abscesses' puncture: technical case report. Acta Neurochir (Wien) 2022; 164:845-851. [PMID: 34410501 DOI: 10.1007/s00701-021-04955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
We report a case of multiple brain abscesses' puncture, employing the ROSA™ Brain surgical robot (Zimmer Biomet) and the O-arm® O2 Imaging System (Medtronic). A 51-year-old man was diagnosed with multiple supratentorial ring enhancing cystic lesions consistent with brain abscesses. A neurological deterioration occurred despite broad spectrum antibiotic therapy, due to mass effect of the abscesses. Stereotactic aspiration was performed using the described technique, allowing a single stage puncture of the cerebral lesions. In this case, the robot-assisted and image-guided procedure permitted an accurate, quick, and efficient targeting of the multiple abscesses for drainage.
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17
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Vagdargi P, Uneri A, Jones CK, Wu P, Han R, Luciano MG, Anderson WS, Helm PA, Hager GD, Siewerdsen JH. Pre-Clinical Development of Robot-Assisted Ventriculoscopy for 3D Image Reconstruction and Guidance of Deep Brain Neurosurgery. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2022; 4:28-37. [PMID: 35368731 PMCID: PMC8967072 DOI: 10.1109/tmrb.2021.3125322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Conventional neuro-navigation can be challenged in targeting deep brain structures via transventricular neuroendoscopy due to unresolved geometric error following soft-tissue deformation. Current robot-assisted endoscopy techniques are fairly limited, primarily serving to planned trajectories and provide a stable scope holder. We report the implementation of a robot-assisted ventriculoscopy (RAV) system for 3D reconstruction, registration, and augmentation of the neuroendoscopic scene with intraoperative imaging, enabling guidance even in the presence of tissue deformation and providing visualization of structures beyond the endoscopic field-of-view. Phantom studies were performed to quantitatively evaluate image sampling requirements, registration accuracy, and computational runtime for two reconstruction methods and a variety of clinically relevant ventriculoscope trajectories. A median target registration error of 1.2 mm was achieved with an update rate of 2.34 frames per second, validating the RAV concept and motivating translation to future clinical studies.
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Affiliation(s)
- Prasad Vagdargi
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Ali Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Craig K. Jones
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD USA
| | - Pengwei Wu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Runze Han
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Mark G. Luciano
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | | | - Gregory D. Hager
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Jeffrey H. Siewerdsen
- Department of Biomedical Engineering and Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
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18
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Narsinh KH, Paez R, Mueller K, Caton MT, Baker A, Higashida RT, Halbach VV, Dowd CF, Amans MR, Hetts SW, Norbash AM, Cooke DL. Robotics for neuroendovascular intervention: Background and primer. Neuroradiol J 2022; 35:25-35. [PMID: 34398721 PMCID: PMC8826289 DOI: 10.1177/19714009211034829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The simultaneous growth of robotic-assisted surgery and telemedicine in recent years has only been accelerated by the recent coronavirus disease 2019 pandemic. Robotic assistance for neurovascular intervention has garnered significant interest due to opportunities for tele-stroke models of care for remote underserved areas. Lessons learned from medical robots in interventional cardiology and neurosurgery have contributed to incremental but vital advances in medical robotics despite important limitations. In this article, we discuss robot types and their clinical justification and ethics, as well as a general overview on available robots in thoracic/abdominal surgery, neurosurgery, and cardiac electrophysiology. We conclude with current clinical research in neuroendovascular intervention and a perspective on future directions.
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Affiliation(s)
- Kazim H Narsinh
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA,Kazim H Narsinh and Daniel L Cooke, UCSF
Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, L-309, San
Francisco, CA 94117, USA. ;
| | - Ricardo Paez
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | | | - M Travis Caton
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Amanda Baker
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Randall T Higashida
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Van V Halbach
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Christopher F Dowd
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Matthew R Amans
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | - Steven W Hetts
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA
| | | | - Daniel L Cooke
- Department of Radiology and
Biomedical Imaging, University of California San Francisco, USA,Kazim H Narsinh and Daniel L Cooke, UCSF
Department of Radiology and Biomedical Imaging, 505 Parnassus Avenue, L-309, San
Francisco, CA 94117, USA. ;
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19
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Bibi Farouk ZI, Jiang S, Yang Z, Umar A. A Brief Insight on Magnetic Resonance Conditional Neurosurgery Robots. Ann Biomed Eng 2022; 50:138-156. [PMID: 34993701 DOI: 10.1007/s10439-021-02891-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022]
Abstract
The brain is a delicate organ in the human body that requires extreme care. Brain-related diseases are unavoidable. Perse, neurosurgery is a complicated procedure that demands high precision and accuracy. Developing a surgical robot is a complex task. To date, there are only a handful of neurosurgery robots in the market that distinctly undergo clinical procedures. These robots have exorbitant cost that hinders the utmost care progress in the area as they are unaffordable. This paper looked at the historical perspective and presented insight literature of the magnetic resonance conditional stereotactic neurosurgery robots that find their ways in clinics, abandoning research projects and promising research yet to undergo clinical use. In addition, the study also gives a thorough insight into the advantage of magnetic resonance imaging modalities and magnetic resonance conditional robots and the future challenges in automation use. Image compatibility test data and accuracy results are also examined because they guarantee that these systems work correctly in particular imaging settings. The primary differences between these systems include actuation and control technologies, construction materials, and the degree of freedom. Thus, one system has an advantage over the other.
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Affiliation(s)
- Z I Bibi Farouk
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China
| | - Shan Jiang
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China.
| | - Zhiyong Yang
- Mechanical Engineering Department, Tianjin University, No. 135, Yaguan Road, Haihe Education Park, Jinnan District, Tianjin, 300354, China
| | - Abubakar Umar
- Mechanical Engineering Department, Hebei University of Technology, Tianjin, China
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20
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Wang TY, Park C, Dalton T, Rajkumar S, McCray E, Owolo E, Than KD, Abd-El-Barr MM. Robotic navigation in spine surgery: Where are we now and where are we going? J Clin Neurosci 2021; 94:298-304. [PMID: 34863454 DOI: 10.1016/j.jocn.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/31/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
Robotic navigation is a new and rapidly emerging niche within minimally invasive spine surgery. The robotic arms-race began in 2004 and has resulted in no less than four major robotic surgical adjuncts. Current Food and Drug Administration (FDA)-approved applications of robotic navigation are limited to pedicle screw instrumentation, but new indications and experimental applications are rapidly emerging. As with any new technology, robotic navigation must be vetted for clinical efficacy, efficiency, safety, and cost-effectiveness. Given the rapid advancements made on a yearly basis, it is important to make frequent and objective assessments of the available technology. Thus, the authors seek to provide the most up-to-date review of the history, currently available technology, learning curve, novel applications, and cost effectiveness of today's available robotic systems as it relates to spine surgery.
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Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
| | | | - Tara Dalton
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Edwin McCray
- School of Medicine, Duke University, Durham, NC, USA
| | - Edwin Owolo
- School of Medicine, Duke University, Durham, NC, USA
| | - Khoi D Than
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA
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21
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Li L, Yang S, Peng W, Ding H, Wang G. A CT Image-Based Virtual Sensing Method to Estimate Bone Drilling Force for Surgery Robots. IEEE Trans Biomed Eng 2021; 69:871-881. [PMID: 34460361 DOI: 10.1109/tbme.2021.3108400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective: Understanding medical images like the human surgeon is a challenge for current surgical robots. It is still hard for surgical robots to achieve safe and stable operations with the help of priori information from preoperative images. We proposed a method to estimate drilling force information based on preoperative images, which can provide priori force information for surgical robots to perform bone drilling tasks. METHODS A visual sensing computing framework is proposed to obtain the 3D image information from the drill-tissue contact area in a one-dimensional signal format. Under this computing framework, a computed tomography (CT) image-weighted bone drilling mechanical model is built. The model considers both targets bone shape and material properties to predict the thrust force, torque, and radial force of a drilling process based on preoperative CT images. RESULTS The built model can respond to multiple bone drilling process factors, such as personalized surgery plans, varying tissue densities, uneven drilling surfaces, different drilling speeds, feed rates, and drill bit geometries. The minimum error of the predicted thrust force on bovine bones is 1.130.95 N, and the best normalized average prediction error on porcine bones is 0.070.08. Experiments in spinal pedicle screw placement surgery also show potential application abilities. CONCLUSION Our method predicts the bone drilling force well based on preoperative images, providing robots with more efficient preoperative information. SIGNIFICANCE This work offers a new perspective to study the interaction relationship between robot surgical instruments and tissues with the assistance of preoperative images.
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22
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Abstract
OBJECT The purpose of this review is to highlight the major factors limiting the progress of robotics development in the field of cranial neurosurgery. METHODS A literature search was performed focused on published reports of any Neurosurgical technology developed for use in cranial neurosurgery. Technology was reviewed and assessed for strengths and weaknesses, use in patients and whether or not the project was active or closed. RESULTS Published reports of 24 robots are discussed going back to 1985. In total, there were 9 robots used in patients (PUMA, Robot Hand, EXPERT, Neuromate, Evolution 1, ROSA, iSYS1, NeuroArm and NeuRobot) and only 2 active today (ROSA, NeuroArm). Of all clinically active systems, only three were used in more than 30 patients (ROSA, iSYS1 & NeuroArm). Projects were limited by cost, technology adoption, and clinical utility to actually improve workflow. The most common use of developed robots is for Stereotaxis. CONCLUSIONS There is a clear void in the area of cranial neurosurgery regarding robotics technology despite success in other fields of surgery. Significant factors such as cost, technology limitations, market size and regulatory pathway all contribute to a steep gradient for success.
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Affiliation(s)
- Rami Elsabeh
- Brain and Spine Surgeons of New York, White Plains, NY, USA
| | - Sukhbir Singh
- Brain and Spine Surgeons of New York, White Plains, NY, USA
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23
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McGlynn E, Nabaei V, Ren E, Galeote‐Checa G, Das R, Curia G, Heidari H. The Future of Neuroscience: Flexible and Wireless Implantable Neural Electronics. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2002693. [PMID: 34026431 PMCID: PMC8132070 DOI: 10.1002/advs.202002693] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/15/2021] [Indexed: 05/04/2023]
Abstract
Neurological diseases are a prevalent cause of global mortality and are of growing concern when considering an ageing global population. Traditional treatments are accompanied by serious side effects including repeated treatment sessions, invasive surgeries, or infections. For example, in the case of deep brain stimulation, large, stiff, and battery powered neural probes recruit thousands of neurons with each pulse, and can invoke a vigorous immune response. This paper presents challenges in engineering and neuroscience in developing miniaturized and biointegrated alternatives, in the form of microelectrode probes. Progress in design and topology of neural implants has shifted the goal post toward highly specific recording and stimulation, targeting small groups of neurons and reducing the foreign body response with biomimetic design principles. Implantable device design recommendations, fabrication techniques, and clinical evaluation of the impact flexible, integrated probes will have on the treatment of neurological disorders are provided in this report. The choice of biocompatible material dictates fabrication techniques as novel methods reduce the complexity of manufacture. Wireless power, the final hurdle to truly implantable neural interfaces, is discussed. These aspects are the driving force behind continued research: significant breakthroughs in any one of these areas will revolutionize the treatment of neurological disorders.
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Affiliation(s)
- Eve McGlynn
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Vahid Nabaei
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Elisa Ren
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Gabriel Galeote‐Checa
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Rupam Das
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Giulia Curia
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Hadi Heidari
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
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24
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Duan X, Tian H, Li C, Han Z, Cui T, Shi Q, Wen H, Wang J. Virtual-Fixture Based Drilling Control for Robot-Assisted Craniotomy: Learning From Demonstration. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3061388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Zheng L, Zhang Z, Wang Z, Bao K, Yang L, Yan B, Yan Z, Ye W, Yang R. A multiple closed-loops robotic calibration for accurate surgical puncture. Int J Med Robot 2021; 17:e2242. [PMID: 33591646 DOI: 10.1002/rcs.2242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic puncture system increasingly demands stringent standard in target location accuracy. The positional and orientational transformation relationships among all components of the system are supposed to be calibrated and identified preoperatively. AIMS The target location performance is directly determined by the calibration result. Therefore, a multiple closed-loops calibration approach is proposed to achieve high-level calibration accuracy in robotic puncture system. MATERIALS & METHODS: This method takes as input the three-dimensional position information of the retro-reflective markers mounted on the surgical tool, which is detected by the optical tracking system in real time during robotic movement. There is less complicated mathematical derivation and calculation in the presented algorithm by applying the closed-loop principle. RESULTS Experimental results validate that it can achieve accurate robotic target location with less input data and computation-cost, satisfying the clinical puncture requirements. DISCUSSION The spatial calibration between robotic arm and optical tracking system efficiently realised by the presented approach present an alternative which can be safely applied to the robotic puncture system for accurate insertion. CONCLUSION Overall, a multiple closed-loops calibration approach is proposed in this work, which may increase surgical efficiency.
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Affiliation(s)
- Lingxiang Zheng
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Zhesi Zhang
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | | | - Kaiyang Bao
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Lin Yang
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Biao Yan
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Zeping Yan
- School of Mathematics, University of Edinburgh, Edinburgh, UK
| | - Weitao Ye
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Rongqian Yang
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
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D'Souza M, Gendreau J, Feng A, Kim LH, Ho AL, Veeravagu A. Robotic-Assisted Spine Surgery: History, Efficacy, Cost, And Future Trends. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2019; 6:9-23. [PMID: 31807602 PMCID: PMC6844237 DOI: 10.2147/rsrr.s190720] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/14/2019] [Indexed: 01/02/2023]
Abstract
Robot-assisted spine surgery has recently emerged as a viable tool to enable less invasive and higher precision surgery. The first-ever spine robot, the SpineAssist (Mazor Robotics Ltd., Caesarea, Israel), gained FDA approval in 2004. With its ability to provide real-time intraoperative navigation and rigid stereotaxy, robotic-assisted surgery has the potential to increase accuracy while decreasing radiation exposure, complication rates, operative time, and recovery time. Currently, robotic assistance is mainly restricted to spinal fusion and instrumentation procedures, but recent studies have demonstrated its use in increasingly complex procedures such as spinal tumor resections and ablations, vertebroplasties, and deformity correction. However, robots do require high initial costs and training, and thus, require justification for their incorporation into common practice. In this review, we discuss the history of spinal robots along as well as currently available systems. We then examine the literature to evaluate accuracy, operative time, complications, radiation exposure, and costs – comparing robotic-assisted to traditional fluoroscopy-assisted freehand approaches. Finally, we consider future applications for robots in spine surgery.
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Affiliation(s)
| | | | - Austin Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lily H Kim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Research on motion pattern recognition of exoskeleton robot based on multimodal machine learning model. Neural Comput Appl 2019. [DOI: 10.1007/s00521-019-04567-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Spine surgical robotics: review of the current application and disadvantages for future perspectives. J Robot Surg 2019; 14:11-16. [DOI: 10.1007/s11701-019-00983-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
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29
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Stereotactic brain biopsy: evaluation of robot-assisted procedure in 60 patients. Acta Neurochir (Wien) 2019; 161:545-552. [PMID: 30675655 DOI: 10.1007/s00701-019-03808-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers. Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robot-assisted technology is necessary in particular, when a team has chosen to switch from one to another method. OBJECTIVE The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60 patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data. METHODS We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assisted stereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure included Magnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with a touch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Data collected were success rate, bleeding, clinical worsening, infection, and mortality. RESULTS All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion was glial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinical impairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did not report any infection and mortality. CONCLUSION Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. The operating time can be reduced, without increasing morbidity and mortality rates.
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VanSickle D, Volk V, Freeman P, Henry J, Baldwin M, Fitzpatrick CK. Electrode Placement Accuracy in Robot-Assisted Asleep Deep Brain Stimulation. Ann Biomed Eng 2019; 47:1212-1222. [PMID: 30796551 DOI: 10.1007/s10439-019-02230-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
Abstract
Deep brain stimulation (DBS) involves the implantation of electrodes into specific central brain structures for the treatment of Parkinson's disease. Image guidance and robot-assisted techniques have been developed to assist in the accuracy of electrode placement. Traditional DBS is performed with the patient awake and utilizes microelectrode recording for feedback, which yields lengthy operating room times. Asleep DBS procedures use imaging techniques to verify electrode placement. The objective of this study is to demonstrate the validity of an asleep robot-assisted DBS procedure that utilizes intraoperative imaging techniques for precise electrode placement in a large, inclusive cohort. Preoperative magnetic resonance imaging (MRI) was used to plan the surgical procedure for the 128 patients that underwent asleep DBS. During the surgery, robot assistance was used during the implantation of the electrodes. To verify electrode placement, intraoperative CT scans were fused with the preoperative MRIs. The mean radial error of all final electrode placements is 0.85 ± 0.38 mm. MRI-CT fusion error is 0.64 ± 0.40 mm. The average operating room time for bilateral and unilateral implantations are 139.3 ± 34.7 and 115.4 ± 42.1 min, respectively. This study shows the validity of the presented asleep DBS procedure using robot assistance and intraoperative CT verification for accurate electrode placement with shorter operating room times.
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Affiliation(s)
- David VanSickle
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA.,Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Victoria Volk
- Micron School of Materials Science and Engineering, Boise State University, Boise, ID, USA.,Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Patricia Freeman
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA
| | - Jamie Henry
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA
| | - Meghan Baldwin
- Littleton Adventist Hospital, Centura Health, Littleton, CO, USA
| | - Clare K Fitzpatrick
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA.
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31
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Guo Z, Leong MCW, Su H, Kwok KW, Chan DTM, Poon WS. Techniques for Stereotactic Neurosurgery: Beyond the Frame, Toward the Intraoperative Magnetic Resonance Imaging–Guided and Robot-Assisted Approaches. World Neurosurg 2018; 116:77-87. [DOI: 10.1016/j.wneu.2018.04.155] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 11/16/2022]
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32
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Hong C, Xiaosheng Y, Chengdong W, Jiahui W. An active contour model for brain magnetic resonance image segmentation based on multiple descriptors. INT J ADV ROBOT SYST 2018. [DOI: 10.1177/1729881418783413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
With the increasing use of surgical robots, robust and accurate segmentation techniques for brain tissue in the brain magnetic resonance image are needed to be embedded in the robot vision module. However, the brain magnetic resonance image segmentation results are often unsatisfactory because of noise and intensity inhomogeneity. To obtain accurate segmentation of brain tissue, one new multiphase active contour model, which is based on multiple descriptors mean, variance, and the local entropy, is proposed in this study. The model can bring about a more full description of local intensity distribution. Also, the entropy is introduced to improve the performance of robustness to noise of the algorithm. The segmentation and bias correction for brain magnetic resonance image can be simultaneously incorporated by introducing the bias factor in the proposed approach. At last, three experiments are carried out to test the performance of the method. The results in the experiments show that method proposed in this study performed better than most current methods in regard to accuracy and robustness. In addition, the bias-corrected images obtained by proposed method have better visual effect.
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Affiliation(s)
- Chen Hong
- Faculty of Robot Science and Engineering, Northeastern University, Shenyang, China
- College of Physics Science & Technology, Anshan Normal University, Anshan, China
| | - Yu Xiaosheng
- Faculty of Robot Science and Engineering, Northeastern University, Shenyang, China
| | - Wu Chengdong
- Faculty of Robot Science and Engineering, Northeastern University, Shenyang, China
| | - Wu Jiahui
- Faculty of Robot Science and Engineering, Northeastern University, Shenyang, China
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33
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Impact of robot-assisted spine surgery on health care quality and neurosurgical economics: A systemic review. Neurosurg Rev 2018; 43:17-25. [DOI: 10.1007/s10143-018-0971-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/26/2018] [Accepted: 03/21/2018] [Indexed: 12/24/2022]
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34
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Pang Z, Yang G, Khedri R, Zhang YT. Introduction to the Special Section: Convergence of Automation Technology, Biomedical Engineering, and Health Informatics Toward the Healthcare 4.0. IEEE Rev Biomed Eng 2018. [DOI: 10.1109/rbme.2018.2848518] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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35
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Dlaka D, Švaco M, Chudy D, Jerbić B, Šekoranja B, Šuligoj F, Vidaković J, Almahariq F, Romić D. Brain biopsy performed with the RONNA G3 system: a case study on using a novel robotic navigation device for stereotactic neurosurgery. Int J Med Robot 2017; 14. [PMID: 29232764 DOI: 10.1002/rcs.1884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Robotic neuronavigation is becoming an important tool for neurosurgeons. We present a case study of a frameless stereotactic biopsy guided by the RONNA G3 robotic neuronavigation system. METHODS A 45 year-old patient with a history of vertigo, nausea and vomiting was diagnosed with multiple periventricular lesions. Neurological status was unremarkable. A frameless robotic biopsy of a brain lesion was performed. RESULTS Three tissue samples were obtained. There were no intraoperative or postoperative complications. Histological analysis showed a B-cell lymphoma. After merging the preoperative CT scan with the postoperative MRI and CT scans, the measured error between the planned and the postoperatively measured entry point was 2.24 mm and the measured error between the planned and postoperatively measured target point was 2.33 mm. CONCLUSIONS The RONNA G3 robotic system was used to navigate a Sedan brain biopsy needle to take tissue samples and could be a safe and precise tool for brain biopsy.
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Affiliation(s)
- Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Švaco
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Jerbić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Šekoranja
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Filip Šuligoj
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Vidaković
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Fadi Almahariq
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dominik Romić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
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A surgical robot with augmented reality visualization for stereoelectroencephalography electrode implantation. Int J Comput Assist Radiol Surg 2017; 12:1355-1368. [PMID: 28664416 DOI: 10.1007/s11548-017-1634-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Using existing stereoelectroencephalography (SEEG) electrode implantation surgical robot systems, it is difficult to intuitively validate registration accuracy and display the electrode entry points (EPs) and the anatomical structure around the electrode trajectories in the patient space to the surgeon. This paper proposes a prototype system that can realize video see-through augmented reality (VAR) and spatial augmented reality (SAR) for SEEG implantation. The system helps the surgeon quickly and intuitively confirm the registration accuracy, locate EPs and visualize the internal anatomical structure in the image space and patient space. METHODS We designed and developed a projector-camera system (PCS) attached to the distal flange of a robot arm. First, system calibration is performed. Second, the PCS is used to obtain the point clouds of the surface of the patient's head, which are utilized for patient-to-image registration. Finally, VAR is produced by merging the real-time video of the patient and the preoperative three-dimensional (3D) operational planning model. In addition, SAR is implemented by projecting the planning electrode trajectories and local anatomical structure onto the patient's scalp. RESULTS The error of registration, the electrode EPs and the target points are evaluated on a phantom. The fiducial registration error is [Formula: see text] mm (max 1.22 mm), and the target registration error is [Formula: see text] mm (max 1.18 mm). The projection overlay error is [Formula: see text] mm, and the TP error after the pre-warped projection is [Formula: see text] mm. The TP error caused by a surgeon's viewpoint deviation is also evaluated. CONCLUSION The presented system can help surgeons quickly verify registration accuracy during SEEG procedures and can provide accurate EP locations and internal structural information to the surgeon. With more intuitive surgical information, the surgeon may have more confidence and be able to perform surgeries with better outcomes.
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Carai A, Mastronuzzi A, De Benedictis A, Messina R, Cacchione A, Miele E, Randi F, Esposito G, Trezza A, Colafati GS, Savioli A, Locatelli F, Marras CE. Robot-Assisted Stereotactic Biopsy of Diffuse Intrinsic Pontine Glioma: A Single-Center Experience. World Neurosurg 2017; 101:584-588. [PMID: 28254596 DOI: 10.1016/j.wneu.2017.02.088] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is a childhood tumor with a dismal prognosis. Emerging molecular signatures have paved the way for stereotactic biopsy in selected centers. We present our experience in DIPG stereotactic needle biopsy using the Robotic Stereotactic-Assisted system (ROSA) in a series of consecutive pediatric patients. METHODS All stereotactic biopsy procedures for DIPG performed during the last year at our institution were considered. All procedures were carried out using the ROSA surgical assistant through a precoronary approach. All children underwent a postoperative computed tomography scan to document possible surgical complications and confirm the site of biopsy. Postoperative clinical changes were recorded to test morbidity of the procedure. RESULTS In the last year, we performed 7 pontine needle biopsies. Specimens were diagnostic and useful for molecular analysis in all cases. No surgical complications were observed. One child showed a transient neurologic worsening related to the biopsy that resolved within 2 weeks. The combination of the precoronary approach and use of the stereotactic ROSA system allowed single-session surgeries in all cases. CONCLUSIONS Pontine biopsy for DIPG is a safe procedure in selected centers. The advantages of the single-session procedure we described might be of particular interest in the pediatric setting.
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Affiliation(s)
- Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Raffaella Messina
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Evelina Miele
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giacomo Esposito
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Trezza
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | | | - Alessandra Savioli
- Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Pediatric Science, University of Pavia, Pavia, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Lin CC, Lin HC, Lee WY, Lee ST, Wu CT. Neurosurgical robotic arm drilling navigation system. Int J Med Robot 2016; 13. [PMID: 27910205 DOI: 10.1002/rcs.1790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/22/2016] [Accepted: 10/23/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this work was to develop a neurosurgical robotic arm drilling navigation system that provides assistance throughout the complete bone drilling process. METHODS The system comprised neurosurgical robotic arm navigation combining robotic and surgical navigation, 3D medical imaging based surgical planning that could identify lesion location and plan the surgical path on 3D images, and automatic bone drilling control that would stop drilling when the bone was to be drilled-through. Three kinds of experiment were designed. RESULTS The average positioning error deduced from 3D images of the robotic arm was 0.502 ± 0.069 mm. The correlation between automatically and manually planned paths was 0.975. The average distance error between automatically planned paths and risky zones was 0.279 ± 0.401 mm. The drilling auto-stopping algorithm had 0.00% unstopped cases (26.32% in control group 1) and 70.53% non-drilled-through cases (8.42% and 4.21% in control groups 1 and 2). CONCLUSIONS The system may be useful for neurosurgical robotic arm drilling navigation.
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Affiliation(s)
- Chung-Chih Lin
- Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taiwan.,Department of Neurosurgery, Chang Gung Memorial Hospital, Taiwan
| | - Hsin-Cheng Lin
- Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taiwan
| | - Wen-Yo Lee
- Department of Computer Information and Network Engineering, Lunghwa University of Science and Technology, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taiwan.,Medical Augmented Reality Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taiwan.,Medical Augmented Reality Research Center, Chang Gung Memorial Hospital, Taiwan
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Chan AY, Lin JJ, Mnatsakanyan L, Sazgar M, Sen-Gupta I, Hsu FP, Vadera S. Robot-assisted placement of depth electrodes along the long Axis of the amygdalohippocampal complex. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2016. [DOI: 10.1016/j.inat.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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