Robotic Applications in Neurosurgery

Abstract

Recent advances in neuro-imaging and stereotactic and computer technology gave birth to minimally invasive keyhole surgery to the extent that the scale of neurosurgical procedures, demanded by patients, will soon be so small that it will not be within the capability of the most gifted and skilled neurosurgeons of today. Neurosurgical robotics is the natural progression in this field. Furthermore, the economic advantages, increased precision and improved quality in industrial applications of robotics have stimulated robotic applications in neurosurgery. These neurosurgical robots have significant manipulative advantages over neurosurgeons; neuro-robots are reliable to perform the same procedure over and over, again and again without tiresomeness, variation or boredom. They possess near absolute geometric accuracy and are impervious to biohazards and hostile environments and can work through very narrow and long surgical corridors most suited for surgery on the brain, which is an organ uniquely suited for robotic applications; it is symmetrically confined within a rigid container, the skull, and the brain can be easily damaged by even the smallest excursions of surgical instruments. Robots can also see around corners that are beyond the line of sight of the neurosurgeons during operations and in a way, robots extend the visual and manual dexterity of neurosurgeons beyond their limits. Several ergometric studies during surgery were reported (Berguer, 1999) that have demonstrated substantial muscle fatigue occurring during procedures related to procedure duration and the angle of surgical instruments. Over the last two decades several systems were developed for use in neurosurgery; some of these neuro-robots have been used in clinical practice while others have not been near a patient because of safety and ethical concerns. Among those robots which were used included the PUMA 200 (Kwoh et al., 1985 and Drake et al., 1991), the Minerva robot from the University of Lausanne in Swtizerland (Burckhart et al., 1995), the NeuroMate from Integrated Surgical Systems (Benabid et al., 1987 & 1998), the MRI compatible robot developed in Japan (Masamune et al., 1995), the Evolution 1 (Universal Robotics Systems, Schwerin, Germany), the CyberKnife (Accuracy Inc, Sunnyvale, CA), the RoboSim neurosurgery simulator (Radstzky & Radolph, 2001), the neuroArm (Louw et al., 2004), the PathFinder (Eljamel, 2006) and lastly the SpineAssist (Shoham et al., 2007). Robots were also integrated within current neurosurgical tools such as the microscope, the SurgiScope stereotactic system (Elkta AB, Stockholm, Sweeden) and the MKM microscope system (Carl Zeiss Inc, Oberkochen, Germany). O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m