Evolution of Robotics in Neurosurgery

Abstract

Technology and neurosurgery have gone hand in hand since a long time. Technological development of robotics in neurosurgery over the last couple of decades has been rapid, yet it still has a long way to go before it becomes a "routine" element of the standard neurosurgical procedure. Apart from the obvious advantages they have over humans, that is, precision, consistency, endurance, and reproducibility, robots also provide additional freedom of movement beyond what is anatomically feasible for humans. Since its first practical application in 1985, the promise of robotics has spurred development and design of numerous such devices for application in neurosurgery. In the current era, the role of robots in neurosurgery is limited to programming movements and planning trajectories for deep cranial targets, biopsies, spinal screw placements, deep brain stimulation, and stereotactic radiosurgery. This narrative, nonsystematic review discusses the evolution of various robotic systems, with a focus on their neurosurgical applications.

Keywords: computer-aided surgery; evolution; image-guided surgery; minimally invasive neurosurgery; robotic neurosurgery.

Fig. 1

Supervisory-controlled robot system. The surgeon enters the plan in a computer using the patient's data before the actual surgery. The plan then gets downloaded to the robotic system, which then implements the plan under supervision and close observation of the surgical team.

Fig. 2

Telesurgical robot system. The surgeon (master) maneuvers the robotic arms (slave) from the computer console room under guidance of real-time imaging and the tactile feedback elicited via haptic technology.

Fig. 3

Shared-control robot system. The surgeon and the robot jointly sharing the surgical task. Primary control remains with the surgeon, while the robot provides assistance in the form of armrest, steadying the hand movements, etc.

Fig. 4

( A ) Use of iArmS in microneurosurgery in the locked position. ( B ) Demonstration of its adaptability in various positions taken by the surgeon. (These images are provided courtesy of Dr. Tetsuya Goto from Shinshu University.)

Fig. 5

Robot-assisted neurosurgical suite comprising the neurosurgical robot (Bhabha Atomic Research Centre, Mumbai and Tata Memorial Centre, Mumbai), surgical coordinate measuring mechanism, and visualization.

Fig. 6

Timeline of significant technological development and evolution of robotic systems in neurosurgery.