Robotic Neurosurgery


 
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Advancements in technology are allowing us to perform surgery in ways that are more efficient, more accurate, and less invasive than ever before. Robotic tools are one such advancement, and they are now being applied across a variety of surgical disciplines - including neurosurgery. I use a state-of-the-art Rosa robot in my practice at Swedish Medical Center.

The term “robotic surgery” can be misleading, because it sounds like a robot is performing surgery - not a surgeon. This is not the case! You can think of a robot as a tool or an extension of the surgeon that helps make certain tasks more efficient and safe.

I use a Rosa robot to target parts of the brain precisely and accurately. The process starts with an MRI or CT scan of the brain. I import the images into 3D planning software (see below), select the target(s) for surgery within the brain, and then orient the robot to where the patient’s head is. The robot arm then aims my instruments with sub-millimeter accuracy, allowing me to reach each target without disturbing brain tissue around it.

I use the Rosa robot to perform procedures that require very accurate targeting in the brain: deep brain stimulation, responsive neurostimulation (NeuroPace), laser ablation, stereotactic EEG (SEEG), and brain biopsy. In each of these cases, the robot does not perform the procedure (in fact, it does not touch the patient!); rather, it guides me accurately to the target and lets me do the rest.

I think the use of robotics in neurosurgery simplifies the workflow, shortens procedure length, and improves safety and accuracy.

3D software (left panel) is used to plan implantation of depth electrodes (SEEG) to study a patient’s seizures. The robot guides me to each of my selected trajectories, allowing me to implant the probes accurately through only tiny incisions in the …

3D software (left panel) is used to plan implantation of depth electrodes (SEEG) to study a patient’s seizures. The robot guides me to each of my selected trajectories, allowing me to implant the probes accurately through only tiny incisions in the skin (right panel), rather than a large craniotomy.

Example use of robot for DBS. The robot arm aims toward the target I select in the brain with sub-millimeter accuracy. I then insert the DBS electrode (right panel).

Example use of robot for DBS. The robot arm aims toward the target I select in the brain with sub-millimeter accuracy. I then insert the DBS electrode (right panel).

 
Use of the Medtronic Mazor robot to place pedicle screws in an OLIF procedure.

Use of a surgical robot to place pedicle screws in an OLIF procedure.

Calibrating the Rosa robot just before starting a deep brain stimulation (DBS) surgery