Introduction: Surgical Robotics in Neurosurgery Review Series

Abstract

In our 2018 white paper titled “Overview of Robotics in Neurosurgery,”1 we highlighted the surgical applications of robotics: The promise of robotics for surgery is large - they have the potential to increase the dexterity of the surgeon, provide minimally-invasive access without loss of surgical ability, feature motion scaling so surgeons can easily manipulate small delicate structures, integrate with image guidance so the robot can avoid critical anatomy, and increase the accuracy and precision of changing that anatomy. Robots for surgery are also becoming more popular and widespread.1 This increase in popularity holds particularly true for the field of Neurosurgery. As such, robotic solutions are more of an exception, rather than the norm. While a number of factors are responsible for the limited applications of robotics in Neurosurgery, primary reasons include cost/benefit tradeoffs, familiarity, and ease of integration into existing clinical workflows. Such factors and limitations are to be expected when adopting new tools, especially ones of a deeply technical nature like robotics.1 At its current stage of adoption, early users of the technology are generally asked to take on more of a burden-in terms of cost, usability, training, and reliability-to gain the potential long-term benefits afforded by this technology.1 This series intends to provide readers with a well-rounded view of the current state of robotic Neurosurgery. It starts with an overview of the path to surgical robotics in Neurosurgery, in which one can gain a better understanding of how robots have evolved over time to fit the needs of different surgical specialties. What follows are reviews of currently available robotic systems and their applications in spine and cranial Neurosurgery. The series is completed with a discussion of the future of robotics in Neurosurgery that touches on advances in imaging, machine learning, and novel interfaces. Potential hurdles regarding safety, implementation, and regulatory concerns are laid out to provide a roadmap for advancing robotic and automation technologies. Over the past several years, robotic applications have spread from stereotactic and spinal instrumentation applications to endoscopic and endovascular applications. While this rapid growth and expansion is promising, significant advances are still necessary before robotics can be considered an essential component of Neurosurgery. We hope that a better understanding of the past, present, and future of robotics will help readers appreciate the pros and cons of this technology. Funding This study did not receive any funding or financial support. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.