Update: Robotic neurosurgery

Robotic neurosurgery

Advances in robotic medicine have been adopted by various surgical subspecialties as the benefits of this technology become more readily apparent: precision in narrow operative windows, tremor controlled movements, and modestly improved outcomes, among others.

The use of robotics in neurosurgery and, particularly, in stereotactic neurosurgery, is becoming more and more adopted because of the great advantages that it offers.

Robotic manipulators easily allow to achieve great precision, reliability, and rapidity in the positioning of surgical instruments or devices in the brain. The aim of a work was to experimentally verify a fully automatic “no hands” surgical procedure. The integration of neuroimaging to data for planning the surgery, followed by application of new specific surgical tools, permitted the realization of a fully automated robotic implantation of leads in brain targets. An anthropomorphic commercial manipulator was utilized. In a preliminary phase, a software to plan surgery was developed, and the surgical tools were tested first during a simulation and then on a skull mock-up. In such a way, several tools were developed and tested, and the basis for an innovative surgical procedure arose. The final experimentation was carried out on anesthetized “large white” pigs. The determination of stereotactic parameters for the correct planning to reach the intended target was performed with the same technique currently employed in human stereotactic neurosurgery, and the robotic system revealed to be reliable and precise in reaching the target. The results of this work strengthen the possibility that a neurosurgeon may be substituted by a machine, and may represent the beginning of a new approach in the current clinical practice. Moreover, this possibility may have a great impact not only on stereotactic functional procedures but also on the entire domain of neurosurgery 1).


In the case of surgery of the skull base, it has just emerged from an experimental phase.

Neurosurgery is one of the first organ systems in which robotic surgery can play a role, due to the high precision that is required to localize and manipulate within the brain, and the relatively fixed landmarks of the cranial anatomy.

Robotic technology has been incorporated into stereotactic and endoscopic procedures 2) 3).

Interest in robotic endoscopic surgery is high because of the small size of the incisions, cosmetic advantages, less invasive surgical techniques, decreased scar tissue, shorter duration of hospitalization and increased cost-effectiveness 4).

Other key neurosurgical applications for robots include robotised microscope 5) , telepresence 6) , and tumor resection 7).

see Stereotactic robot

see Robotic forceps

see Robot assisted angiography


Vascular neurosurgery, in particular, remains open to newer and more cutting edge treatment options for complex pathologies, and robotics may be on the horizon for such advances.

Menaker et al. from the Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. seeked to provide a broad overview of these innovations in vascular neurosurgery for both practitioners well acquainted with robotics and those seeking to become more familiar. Technologies under development for cerebrovascular and endovascular neurosurgery include robot assisted angiography, guided operative microscopes, coil insertion systems, and endoscopic clipping devices. Additionally, robotic systems in the fields of interventional cardiology and radiology have potential applications to endovascular neurosurgery but require proper modifications to navigate complex intracerebral vasculature. Robotic technology is not without drawbacks, as broad implementation may lead to increased cost, training time, and potential delays in emergency situations. Further cultivation of current multidisciplinary technologies and investment into newer systems is necessary before robotics can make a sizable impact in clinical practice 8).

1)

Mazzone P, Arena P, Cantelli L, Spampinato G, Sposato S, Cozzolino S, Demarinis P, Muscato G. Experimental new automatic tools for robotic stereotactic neurosurgery: towards “no hands” procedure of leads implantation into a brain target. J Neural Transm (Vienna). 2016 May 19. [Epub ahead of print] PubMed PMID: 27194228.
2)

Louw DF, Fielding T, McBeth PB, Gregoris D, Newhook P, Sutherland GR. Surgical robotics: A review and neurosurgical prototype development. Neurosurgery. 2004;54(3):525–537.
3)

Mc Beth PB, Louw DF, Rizun PR, Sutherland GR. Robotics in neurosurgery. Am J Surg. 2004;188(4):68–75.
4)

Ichihara S, Bodin F, Pedersen JC, Porto de Melo P, Garcia JC Jr, Facca S, Liverneaux PA. Robotically assisted harvest of the latissimus dorsi muscle: A cadaver feasibility study and clinical test case. Hand Surg Rehabil. 2016 Apr;35(2):81-4. doi: 10.1016/j.hansur.2016.01.002. Epub 2016 Feb 18. PubMed PMID: 27117120.
5)

Giorgi C, Eisenberg H, Costi G, Gallo E, Garibotto G, Casolina DS. Robot-assisted microscope for neurosurgery. J Image Guid Surg. 1995;1(3):158–163.
6)

Hongo K, Goto T, Kakizawa Y, Koyama J, Kawai T, Kan K, et al. Micromanipulator system (NeuRobot): Clinical application in neurosurgery. Int Congr Ser. 2003;1256:509–513.
7)

Benabid AL, Lavallee S, Hoffmann D, Cinquin P, Demongeot J, Danel F. Potential use of robots in endoscopic neurosurgery. Acta Neurochir Suppl (Wien) 1992;54:93–97.
8)

Menaker SA, Shah SS, Snelling BM, Sur S, Starke RM, Peterson EC. Current applications and future perspectives of robotics in cerebrovascular and endovascular neurosurgery. J Neurointerv Surg. 2017 Aug 18. pii: neurintsurg-2017-013284. doi: 10.1136/neurintsurg-2017-013284. [Epub ahead of print] Review. PubMed PMID: 28821626.

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