Epilepsy Talk

Robotic Neurosurgery — The Future is Here Today! | September 21, 2016

“It’s as if I’ve miniaturized my body and gone inside the patient.”

A science breakthrough: Robotic surgery.

In 2014, engineers developed a surgical robot designed to perform brain surgery by entering through the cheek — instead of the skull — that can operate on a patient in an MRI scanner.

It started with a team of Vanderbilt engineers, headed by Associate Professor of Mechanical Engineering Eric Barth who wondered: Is it possible to address epileptic seizures in a less invasive way?

They decided it would be possible.

Here are the basics of robotic surgery which brought them to this point…

Robotic surgery is a type of minimally invasive surgery.

“Minimally invasive” means that instead of operating on patients through large incisions, miniaturized surgical instruments that fit through a series of quarter-inch incisions are used.

By poking through the cheek and entering the brain from underneath, it avoids having to drill through the skull and it is much closer to the target area.

This allows the surgeon to work with greater accuracy at the microscopic level.

The result is:

Less trauma on the body…

Minimal scarring…

Faster recovery time.

Through the innovation of digital imaging technology, combined with optical engineering and improved video displays, surgeons can now operate inside of body cavities for therapeutic intervention — without the larger incisions previously necessary to allow a surgeon’s hands access to the necessary organs.

Inspired by the through-the-cheek technique, neuroscientists implant electrodes in the brain to track brain activity and locate the source of epileptic seizures.

When performing this type of surgery, these miniaturized instruments are mounted on three separate robotic arms — allowing the surgeon maximum range of motion and precision.

A robot’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

The surgeon controls these instruments and the camera from a console located in the operating room.

Placing his fingers into the master controls, he is able to operate all four arms of the robot simultaneously.

The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment, avoiding drilling through the skull altogether.

All this while looking through a stereoscopic high-definition monitor that literally places him inside the patient — giving him a better, more detailed 3-D view of the operating site than the human eye can provide.

“The systems we have now that let us introduce probes into the brain — they deal with straight lines and are only manually guided,” said Dr. Joseph Neimat, an originator of the technology.

They can position a nickel-titanium probe about 1 mm wide to an accuracy of roughly the same dimension.

They can mechanically advance it in millimeter steps like a mechanical pencil, and can also turn it by actuating the shape-memory hardware.

All through a shape-memory alloy needle that can be precisely steered along a curving path — and a robotic platform that can operate inside the powerful magnetic field created by an MRI scanner.

Minimally invasive surgery has caused a change in the route of access and has significantly and irrevocably changed the surgical treatment of most disease processes.

“To have a system with a curved needle and unlimited access would make surgeries minimally invasive, we could do a dramatic surgery with nothing more than a needle stick to the cheek.”

Patients still undergo interventions to treat disease, but minimally invasive surgery makes possible a reduction or complete elimination of the “collateral damage” required to gain access to the organ requiring surgery.

Medical robotics is still a very new idea. And this accessibility is still a procedure to be mastered in the future.

But, as surgeons become more familiar with using robots for surgery, and as more companies provide medical robots, there will come a day when robots are used in almost every hospital.

 

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Resources:

http://robotic-surgery.med.nyu.edu/for-patients/what-robotic-surgery

http://en.wikipedia.org/wiki/Robotic_surgery

http://www.nlm.nih.gov/medlineplus/ency/article/007339.htm

http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/neurology.html

http://www.springer.com/medicine/surgery/journal/11701

http://allaboutroboticsurgery.com/surgicalrobots.html

http://www.sciencedaily.com/releases/2014/10/141015152556.htm

http://www.extremetech.com/extreme/192146-robotic-through-the-cheek-brain-surgery-now-possible-inside-the-all-seeing-eye-of-an-mri

http://www.gizmag.com/brain-surgery-through-cheek-vanderbilt/34284/

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