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Robotics in Cranial Neurosurgery


Key Concepts

  • A robot is a machine that is capable of autonomously executing sets of programmed actions.

  • Most robots in commercial use comprise interacting mechanical and electrical systems, often integrating feedback from one or more sensors, under the control of a computer that is programmed to guide the entire system through specific tasks.

  • Robots provide the ability to execute diverse sets of programmed instructions reliably and repeatedly, often with superhuman speed and accuracy. A ubiquitous feature of industrial robots is the articulated robotic arm, a design feature that dominates contemporary robotic surgery, in part because many such systems are intended to function like the arms and hands of a surgeon.

  • Robotic systems in neurosurgery have been used extensively for stereotactic procedures, including electrode placement and biopsy, and to an increasing extent for minimally invasive ablation. Dexterous robots, with end effectors capable of implementing microsurgical manipulations, are not widely available in neurosurgery, though macrosurgical dexterous robots are in widespread use in other surgical specialties.

  • Excellent haptic feedback, small instruments capable of microsurgical soft tissue management, high-precision image guidance and instrument tracking, and tools for bone removal are all required for progress in neurosurgical robotics. These advances are imminent.

  • Contemporary machine learning techniques will likely lead to increasing levels of autonomy in surgical and neurosurgical robotic systems.

Robots Defined

What is a robot? In contemporary use, the term robot refers to a machine, particularly one with human-like qualities, that is capable of autonomously executing sets of programmed actions. Most robots in commercial use comprise integrated mechanical and electrical systems, often with one or more sensors, under the control of a computer that is programmed to guide the entire system through specific tasks. In many industries, from automobile manufacture to electronics to health care and pharmaceuticals, robotic systems have become essential to the reliable production of high-quality goods and services, providing the ability to execute diverse sets of programmed instructions reliably and repeatedly, often with superhuman speed and accuracy. A ubiquitous feature of industrial robots is the articulated robotic arm. This type of robot has emerged as a dominant design in contemporary robotic surgery, which is perhaps not surprising given that these robots are in many cases intended to function like the arms and hands of a surgeon.

In the next section, we provide a survey of robotic systems currently used in neurosurgery. This survey provides context for the following sections. We subsequently discuss several important principles of modern robotics as they apply to neurosurgical robotics, with an emphasis on robotic arms. Finally, we address important factors limiting the progress of robotics in cranial neurosurgery.

Robotic Systems in Current Use in Cranial Neurosurgery

Stereotactic Radiosurgery

The CyberKnife (Accuray, Sunnyvale, CA) represents one of the earliest and most widely used robotic arm systems in cranial neurosurgery. The CyberKnife device comprises a linear accelerator (the radiation source) that is mounted on a robotic arm and an image-guidance system that tracks tumor and patient motion during treatment to realign the treatment beam in real time. After clinical trials beginning in 1994, the CyberKnife received approval by the US Food and Drug Administration (FDA) for treatment of intracranial tumors in 1999. The robotic component of the system is now almost taken for granted because the system has become so ubiquitous, and stereotactic radiosurgery has become so widely accepted as a therapeutic option in contemporary neurosurgery. Even though the system is completely noninvasive, it exemplifies the paradigm of programmable neurosurgical intervention involving real-time sensing and actuation and, to a limited extent, autonomous, on-the-fly control to compensate for small movements.

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