NEUROSURGICAL ROBOTS
A continuación se transcribe la conferencia que el Profesor Doctor Rafael García de Sola, dará el próximo día 4 en el El «International symposium on navigation and robotics in spinopelvic and head surgery, sobre la utilización de robots especializados en la Neurocirugía. El Coongreso tendrá lugar en las instalaciones del Hospital Ramón y Cajal de Madrid (España).
I would like to thank Drs. Ley and Parajón for their invitation to participate in this exciting meeting about Navigation and Robots in Neurosurgery
I will present and discuss my own experience of adapting and using the ROSA robot as a support when performing endoscopic surgery.
Because, as we know, innovation is a process of continuous evolution,
I will begin by reviewing the important technological advances that have preceded the surgical robotic technology, which is now one of the most innovative developments in Neurosurgery.
Pre-surgical images
Firstly, due to the evolution of MRi and CT-scans, we can now obtain and handle amazing and detailed presurgical images.
Secondly, the recent Neuronavigation Systems with their capacity to incorporate these images.
IONM: Intraoperative neurophysiological monitoring
The third important element is the intraoperative neurophysiological control of neuronal function.
It gives us accurate information about the anatomo-functional relationship.
For instance, as we can see here, we can know the exact location of the sulcus, which leads to this rolandic cavernous angioma and its relationship to the motor area.
NEUROSURGICAL ROBOTS: VISION
Microscope fluorencece
Now, let’s outstand the main tools that have enhanced our surgical capability by giving us a more and more exact picture of the surgical field.
I am talking about the microscope
and the endoscope and their evolved designs that are revolutionizing Neurosurgery
ROBOTS
In spite of these advances, of course, we still need to overcome many surgical limitations.
And robotic technology is at the forefront of neurosurgical innovation
I have been involved with robotic technology for many years.
And in 1995 I registered the word MICROBOT
In 2002 I and some engineers developed and patented the use of a passive robotic arm to study the main types of movement disorders
– Controlled movements
– Spatial awareness
– Steadiness
– Accuracy
Slave: Da Vinci
As you know, there are two main types of surgical robots:
– Slave, exemplified by the Da Vinci robot
Assistant: ROSA (Robotic Surgical Assistant
And Assistant, exemplified by the ROSA robot
The «utopian» operating room
Nowadays there is the ideal of combining the aforementioned developments in:
– Images
– Neuronavigation
– Vision
– Robotic technology
And putting them together in the operating room
Companies such as Zeiss-BrainLab or Synaptive are currently developing devices to achieve this aim.
I have also been pursuing this ideal.
For the last 3 years I have been adapting the ROSA robot as a holder of the endoscope.
The fact that the ROSA robot is a neuronavigation system makes it extremely effective in this capacity because you can know where the tip of the endoscope is.
Applications: Endoscopic-assisted microsurgery
Control of resection
One of the main applications I have found is endoscopic-assisted microsurgery
From the beginning of the operation, we prepare and place the endoscope in the surgical field, held by the ROSA robot.
Microscope – Endoscope
The benefit of the ROSA robot becomes apparent at the end of the microsurgical operation, when we can use of the endoscope as a control of microsurgical resection
Last state of resection
In certain operations, the robot now allows me to use both, the microscope or endoscope interchangeably during surgical resection.
Or as the last stage of tumour excision.
The ROSA robot becomes crucial, when the surgeon could be tired and steadiness could be impaired. Then it helps us to complete the last endoscopic step for total removal.
Another area to be explored is the use of the ROSA robot as an assistant in pure endoscopic surgical approaches.
RESULTS
At the last European ENT meeting, my ENT college, Dr. Mata, presented her positive observations after witnessing operations with the ROSA robot in practice.
The robot has several main advantages.
a) Steadiness
b) Vision of exact anatomic placement of the tip of the endoscope
c) Controlled and precise movements of endoscope
d) Sitting position
e) 3-4 free-handed approaches
CONCLUSIONS
Robotic technology is starting to be applied in Neurosurgery
This technology is becoming more and more user-friendly and is resulting in successful surgery.
One application, as I have said, is using it as a support for endoscopy
The use of the ROSA robot offers good control of microsurgical resections or can work perfectly alongside the microscope. Especially in skull base surgery
The ROSA robot, as an assistant in endoscopic surgery, makes the operation more comfortable and provides continuous anatomic information.
Its movements are precise and controlled at all time and this means better surgical accuracy and surgical efficiency.
INNOVATION IN NEUROSURGERY
Firstly, the generation and application of technological advances
– Outstanding neurosurgeons have generally been responsible for the development of technological advances. This new technology has made it possible for these neurosurgeons to overcome limitations and pioneer new surgical advances.
– When “normal” neurosurgeons become familiar with this technology they, like the innovators, will also improve their performance and achieve results above the average
The second key aspect is efficiency in the operating theatre.
The incorporation of new technology must be logical and add to an atmosphere of harmony in the operating room. This means thinking about where to place each piece of equipment and having a team that is trained and familiar with the technology.
