An Overview of Robotics in Functional Neurosurgery
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paper_title: Robotics: Fundamental Concepts and Analysis

paper_content:

The book introduces the science and engineering of robotics and provides in-depth coverage of mechanical manipulation. ::: ::: Robotics: Fundamental Concepts and Analysis is designed to fully meet the requirements of undergraduate students of mechanical engineering for a course in robotics. With the inclusion of some key advanced topics, the book also serves as an introductory text for postgraduate students specializing in robotics. The book introduces the science and engineering of robotics and provides in-depth coverage of mechanical manipulation. It emphasizes the fundamental mathematical concepts and analytical tools required for a topic, develops the relevant theory and algorithms, and then illustrates the theory with the help of worked-out examples. The book presents all key areas of kinematics, dynamics, and control of manipulators in a single text and treats the kinematics and dynamics of serial and parallel manipulators in a unified way. Newer robotic architectures such as parallel manipulators, flexible manipulators, and mobile robots have also been discussed at length. The book also uses computational software such as MATLAB and MAPLE for problem solving. Written in a comprehensive and concise manner, the text is student friendly and includes several examples and exercise problems.
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paper_title: A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery

paper_content:

The use of a Unimation Puma 200 robot, properly interfaced with a computerized tomographic (CT) scanner and with a probe guide mounted at its end effector for CT-guided brain tumor biopsis is discussed. Once the target is identified on the CT picture, a simple command allows the robot to move to a position such that the end-effector probe guide points toward the target. This results in a procedure faster than one using a manually adjustable frame. Probably the most important advantage, as is shown, is the improved accuracy that can be achieved by proper calibration of the robot. >
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paper_title: NeuroArm: an MR compatible robot for microsurgery

paper_content:

Abstract Introduction: Technologies such as microscopy have pushed surgeons to the limits of their dexterity and endurance. Robotic advances such as tremor filtration and motion scaling permit maximal use of magnification, and enable precise, tremor-free tool manipulation during microsurgery. To our knowledge, however, no such device exists for image-guided, ambidextrous microneurosurgery, prompting us to develop our own system. Methods: We approached a company with exceptional experience in space robotics to design and construct an appropriate system. A systematic and structured approached was followed for the design of neuroArm. Engineers studied the operating room environment with the assistance of surgeons and nursing staff. A preliminary design was developed, and subsequently evaluated by surgical staff. Selected materials were tested at 3.0 T to ensure MR compatibility and performance characteristics of the robot actuators and encoders were evaluated. Results: We have developed an MR compatible ambidextrous robot capable of both microneurosurgery and stereotaxy. The design is based on a SCARA configuration and has 8-DOF (including tool actuation). The end-effector is designed to interface with standard neurosurgical tools and is equipped with a 3-DOF optical force sensor for haptic feedback. Comprehensive testing of materials was conducted in a 3-T magnet to ensure compatibility. Breadboard testing results suggest a tool tip resolution of 30 μm. Discussion: A systematic approach has been applied to the development of a unique and dexterous neurosurgical robot. The system promises to enhance surgical performance, reduce fatigue, and improve surgical outcomes. This seamless integration of robotics with iMRI will further revolutionize neurosurgery.
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paper_title: The evolution of neuroArm.

paper_content:

Intraoperative imaging disrupts the rhythm of surgery despite providing an excellent opportunity for surgical monitoring and assessment. To allow surgery within real-time images, neuroArm, a teleoperated surgical robotic system, was conceptualized. The objective was to design and manufacture a magnetic resonance-compatible robot with a human-machine interface that could reproduce some of the sight, sound, and touch of surgery at a remote workstation. University of Calgary researchers worked with MacDonald, Dettwiler and Associates engineers to produce a requirements document, preliminary design review, and critical design review, followed by the manufacture, preclinical testing, and clinical integration of neuroArm. During the preliminary design review, the scope of the neuroArm project changed to performing microsurgery outside the magnet and stereotaxy inside the bore. neuroArm was successfully manufactured and installed in an intraoperative magnetic resonance imaging operating room. neuroArm was clinically integrated into 35 cases in a graded fashion. As a result of this experience, neuroArm II is in development, and advances in technology will allow microsurgery within the bore of the magnet. neuroArm represents a successful interdisciplinary collaboration. It has positive implications for the future of robotic technology in neurosurgery in that the precision and accuracy of robots will continue to augment human capability.
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paper_title: Frameless stereotactic targeting devices: technical features, targeting errors and clinical results.

paper_content:

BACKGROUND ::: Brain biopsies (BB) and depth electrode placements (DEP) are increasingly performed using frameless stereotactic targeting devices. This paper is intended to provide a comprehensive review of the technical features, targeting errors and clinical results. ::: ::: ::: METHODS ::: A PubMed literature search from 1995-2010 was performed. ::: ::: ::: RESULTS ::: (A) Modified stereotactic arcs, (B) arm-based devices with and without aiming facilities, and (C) skull affixed devices were found. Guidance technologies were navigation systems (all groups), prospective stereotaxy and custom designed platforms (group C). Mean total errors ranged between 4.4 and 5.4 mm for BB and 2.0 and 3.2 mm for DEP. Diagnostic yield of BB was 89-100%. The clinical success rate for DEP was 96-100%. ::: ::: ::: CONCLUSIONS ::: Frameless stereotactic targeting devices may reach targeting errors and clinical results comparable with standard frame-based stereotaxy. Advantages and disadvantages of different devices should be acknowledged to ensure optimal technical performance.
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paper_title: PathFinder image guided robot for neurosurgery

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This paper discusses the benefits that arise from the use of a robot arm for guiding neurosurgical operations. The design and operation of the PathFinder, safety issues and the accuracies that can be obtained and the use of a robot held camera for system calibration are described.
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paper_title: The evolution of neuroArm.

paper_content:

Intraoperative imaging disrupts the rhythm of surgery despite providing an excellent opportunity for surgical monitoring and assessment. To allow surgery within real-time images, neuroArm, a teleoperated surgical robotic system, was conceptualized. The objective was to design and manufacture a magnetic resonance-compatible robot with a human-machine interface that could reproduce some of the sight, sound, and touch of surgery at a remote workstation. University of Calgary researchers worked with MacDonald, Dettwiler and Associates engineers to produce a requirements document, preliminary design review, and critical design review, followed by the manufacture, preclinical testing, and clinical integration of neuroArm. During the preliminary design review, the scope of the neuroArm project changed to performing microsurgery outside the magnet and stereotaxy inside the bore. neuroArm was successfully manufactured and installed in an intraoperative magnetic resonance imaging operating room. neuroArm was clinically integrated into 35 cases in a graded fashion. As a result of this experience, neuroArm II is in development, and advances in technology will allow microsurgery within the bore of the magnet. neuroArm represents a successful interdisciplinary collaboration. It has positive implications for the future of robotic technology in neurosurgery in that the precision and accuracy of robots will continue to augment human capability.
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paper_title: Improved accuracy using a modified registration method of ROSA in deep brain stimulation surgery

paper_content:

OBJECTIVE The aim of this study was to determine whether a modified registration method could reduce registration error and postoperative electrode vector error and to analyze the method's clinical significance in deep brain stimulation (DBS) surgery. METHODS The first part of the study involved a skull model, in which three registration methods were tested using the ROSA (robotic stereotactic assistance) system. In the second part, four registration methods were clinically tested in patients undergoing DBS surgery using the ROSA system. Thirty-three patients (65 sides, group I) underwent the conventional registration method 2E, and registration errors were recorded. Thirty-eight patients (75 sides, group II) underwent four types of modified registration methods including 2A, 2B, 2C, and 2D. Registration and electrode vector errors, intraoperative electrophysiological signal length (IESL), and DBS power-on voltage were recorded. The primary measure of efficacy was the change in the Unified Parkinson's Disease Rating Scale (UPDRS) and UPDRS Part III scores from baseline to 10 weeks after surgery. RESULTS In the skull model, the registration error (mean ± SD) was 0.56 ± 0.11 mm for method 1A, 0.35 ± 0.11 mm for method 1B (vs. 1A, p < 0.001), and 0.90 ± 0.15 mm for method 1C (vs. 1A, p < 0.001). In the clinical study, method 2C was selected for DBS surgery in group II since it had the smallest registration error among the four methods tested. The registration error was 0.62 ± 0.22 mm (mean ± SD) for group I and 0.27 ± 0.07 mm for group II (p < 0.001). Postoperative electrode vector error was 0.97 ± 0.31 mm for group I and 0.65 ± 0.23 mm for group II (p < 0.001). There was a positive correlation between registration error and electrode vector error in both groups (group I: r = 0.69, p < 0.001; group II: r = 0.71, p < 0.001). The mean IESL was 5.0 ± 0.9 mm in group I and 5.8 ± 0.7 mm in group II (p < 0.001). The mean DBS power-on voltage was 1.63 ± 0.44 V in group I and 1.48 ± 0.38 V in group II (p = 0.027). In the UPDRS score, group I showed 50% ± 16% improvement and group II showed 52% ± 18% improvement (p = 0.724); there was no statistically significant difference in improvement on the UPDRS. CONCLUSIONS In DBS surgery assisted by the ROSA system, registration error and electrode vector error showed a positive correlation. The modified registration method could reduce the registration error and electrode vector error, but the long-term effects need to be further observed and evaluated.
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paper_title: Brain biopsy performed with the RONNA G3 system: a case study on using a novel robotic navigation device for stereotactic neurosurgery

paper_content:

BACKGROUND ::: Robotic neuronavigation is becoming an important tool for neurosurgeons. We present a case study of a frameless stereotactic biopsy guided by the RONNA G3 robotic neuronavigation system. ::: ::: ::: METHODS ::: A 45 year-old patient with a history of vertigo, nausea and vomiting was diagnosed with multiple periventricular lesions. Neurological status was unremarkable. A frameless robotic biopsy of a brain lesion was performed. ::: ::: ::: RESULTS ::: Three tissue samples were obtained. There were no intraoperative or postoperative complications. Histological analysis showed a B-cell lymphoma. After merging the preoperative CT scan with the postoperative MRI and CT scans, the measured error between the planned and the postoperatively measured entry point was 2.24 mm and the measured error between the planned and postoperatively measured target point was 2.33 mm. ::: ::: ::: CONCLUSIONS ::: The RONNA G3 robotic system was used to navigate a Sedan brain biopsy needle to take tissue samples and could be a safe and precise tool for brain biopsy.
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paper_title: Automated Marker Localization in the Planning Phase of Robotic Neurosurgery

paper_content:

Accurate patient registration is a critical issue in medical image-guided interventions. The neurosurgical robotic system RObotic Neuro-NAvigation (RONNA) uses four retro-reflective spheres, on a marker attached to the patient’s cranial bone, for patient registration in physical and image space. In this paper, the algorithm for automatic localization of spherical fiducials in CT scans is presented and clinically evaluated. The developed localization algorithm uses a unique approach, which combines machine vision algorithms, biomedical image filtration methods, and mathematical estimation methods. The performance of the localization algorithm was evaluated in comparison with four skilled human operators. The measurements were based on twelve patient and eight lab phantom CT scans. The localization error of the algorithm in comparison with the human readings was smaller by 49.29% according to the ground truth estimation and by 45.91% according to the intra-modal estimation. Localization processing time was reduced by 84.96%. Reliability in terms of successful localization of the fiducial marker was 100% for 20 different test samples containing a total of 116 spherical fiducials. Based on the tests carried out in clinical conditions, the localization algorithm has demonstrated reliability with a high degree of accuracy and short processing time. The developed algorithm provides fully automated and accurate machine vision-based patient localization for the neurosurgical clinical application of the robotic system RONNA.
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paper_title: Neurosurgery and brain shift : review of the state of the art and main contributions of robotics Neurocirugía y desplazamientos cerebrales : una revisión del estado del arte y principales contribuciones desde la robótica

paper_content:

This paper presents a review about neurosurgery, robotic assistants in this type of procedure, and the approach to the problem of brain tissue displacement, including techniques for obtaining medical images. It is especially focused on the phenomenon of brain displacement, commonly known as brain shift, which causes a loss of reference between the preoperative images and the volumes to be treated during image-guided surgery. Hypothetically, with brain shift prediction and correction for the neuronavigation system, minimal invasion trajectories could be planned and shortened. This would reduce damage to functional tissues and possibly lower the morbidity and mortality in delicate and demanding medical procedures such as the removal of a brain tumor. This paper also mentions other issues associated with neurosurgery and shows the way robotized systems have helped solve these problems. Finally, it highlights the future perspectives of neurosurgery, a branch of medicine that seeks to treat the ailments of the main organ of the human body from the perspective of many disciplines.
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paper_title: The evolution of neuroArm.

paper_content:

Intraoperative imaging disrupts the rhythm of surgery despite providing an excellent opportunity for surgical monitoring and assessment. To allow surgery within real-time images, neuroArm, a teleoperated surgical robotic system, was conceptualized. The objective was to design and manufacture a magnetic resonance-compatible robot with a human-machine interface that could reproduce some of the sight, sound, and touch of surgery at a remote workstation. University of Calgary researchers worked with MacDonald, Dettwiler and Associates engineers to produce a requirements document, preliminary design review, and critical design review, followed by the manufacture, preclinical testing, and clinical integration of neuroArm. During the preliminary design review, the scope of the neuroArm project changed to performing microsurgery outside the magnet and stereotaxy inside the bore. neuroArm was successfully manufactured and installed in an intraoperative magnetic resonance imaging operating room. neuroArm was clinically integrated into 35 cases in a graded fashion. As a result of this experience, neuroArm II is in development, and advances in technology will allow microsurgery within the bore of the magnet. neuroArm represents a successful interdisciplinary collaboration. It has positive implications for the future of robotic technology in neurosurgery in that the precision and accuracy of robots will continue to augment human capability.
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paper_title: A review of medical robotics for minimally invasive soft tissue surgery

paper_content:

AbstractThis paper provides an overview of recent trends and developments in medical robotics for minimally invasive soft tissue surgery, with a view to highlight some of the issues posed and solutions proposed in the literature. The paper includes a thorough review of the literature, which focuses on soft tissue surgical robots developed and published in the last five years (between 2004 and 2008) in indexed journals and conference proceedings. Only surgical systems were considered; imaging and diagnostic devices were excluded from the review. The systems included in this paper are classified according to the following surgical specialties: neurosurgery; eye surgery and ear, nose, and throat (ENT); general, thoracic, and cardiac surgery; gastrointestinal and colorectal surgery; and urologic surgery. The systems are also cross-classified according to their engineering design and robotics technology, which is included in tabular form at the end of the paper. The review concludes with an overview of the fie...
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paper_title: Improved accuracy using a modified registration method of ROSA in deep brain stimulation surgery

paper_content:

OBJECTIVE The aim of this study was to determine whether a modified registration method could reduce registration error and postoperative electrode vector error and to analyze the method's clinical significance in deep brain stimulation (DBS) surgery. METHODS The first part of the study involved a skull model, in which three registration methods were tested using the ROSA (robotic stereotactic assistance) system. In the second part, four registration methods were clinically tested in patients undergoing DBS surgery using the ROSA system. Thirty-three patients (65 sides, group I) underwent the conventional registration method 2E, and registration errors were recorded. Thirty-eight patients (75 sides, group II) underwent four types of modified registration methods including 2A, 2B, 2C, and 2D. Registration and electrode vector errors, intraoperative electrophysiological signal length (IESL), and DBS power-on voltage were recorded. The primary measure of efficacy was the change in the Unified Parkinson's Disease Rating Scale (UPDRS) and UPDRS Part III scores from baseline to 10 weeks after surgery. RESULTS In the skull model, the registration error (mean ± SD) was 0.56 ± 0.11 mm for method 1A, 0.35 ± 0.11 mm for method 1B (vs. 1A, p < 0.001), and 0.90 ± 0.15 mm for method 1C (vs. 1A, p < 0.001). In the clinical study, method 2C was selected for DBS surgery in group II since it had the smallest registration error among the four methods tested. The registration error was 0.62 ± 0.22 mm (mean ± SD) for group I and 0.27 ± 0.07 mm for group II (p < 0.001). Postoperative electrode vector error was 0.97 ± 0.31 mm for group I and 0.65 ± 0.23 mm for group II (p < 0.001). There was a positive correlation between registration error and electrode vector error in both groups (group I: r = 0.69, p < 0.001; group II: r = 0.71, p < 0.001). The mean IESL was 5.0 ± 0.9 mm in group I and 5.8 ± 0.7 mm in group II (p < 0.001). The mean DBS power-on voltage was 1.63 ± 0.44 V in group I and 1.48 ± 0.38 V in group II (p = 0.027). In the UPDRS score, group I showed 50% ± 16% improvement and group II showed 52% ± 18% improvement (p = 0.724); there was no statistically significant difference in improvement on the UPDRS. CONCLUSIONS In DBS surgery assisted by the ROSA system, registration error and electrode vector error showed a positive correlation. The modified registration method could reduce the registration error and electrode vector error, but the long-term effects need to be further observed and evaluated.
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paper_title: Review of Robotic Technology for Stereotactic Neurosurgery

paper_content:

The research of stereotactic apparatus to guide surgical devices began in 1908, yet a major part of today's stereotactic neurosurgeries still rely on stereotactic frames developed almost half a century ago. Robots excel at handling spatial information, and are, thus, obvious candidates in the guidance of instrumentation along precisely planned trajectories. In this review, we introduce the concept of stereotaxy and describe a standard stereotactic neurosurgery. Neurosurgeons' expectations and demands regarding the role of robots as assistive tools are also addressed. We list the most successful robotic systems developed specifically for or capable of executing stereotactic neurosurgery. A critical review is presented for each robotic system, emphasizing the differences between them and detailing positive features and drawbacks. An analysis of the listed robotic system features is also undertaken, in the context of robotic application in stereotactic neurosurgery. Finally, we discuss the current perspective, and future directions of a robotic technology in this field. All robotic systems follow a very similar and structured workflow despite the technical differences that set them apart. No system unequivocally stands out as an absolute best. The trend of technological progress is pointing toward the development of miniaturized cost-effective solutions with more intuitive interfaces.
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paper_title: Brain biopsy performed with the RONNA G3 system: a case study on using a novel robotic navigation device for stereotactic neurosurgery

paper_content:

BACKGROUND ::: Robotic neuronavigation is becoming an important tool for neurosurgeons. We present a case study of a frameless stereotactic biopsy guided by the RONNA G3 robotic neuronavigation system. ::: ::: ::: METHODS ::: A 45 year-old patient with a history of vertigo, nausea and vomiting was diagnosed with multiple periventricular lesions. Neurological status was unremarkable. A frameless robotic biopsy of a brain lesion was performed. ::: ::: ::: RESULTS ::: Three tissue samples were obtained. There were no intraoperative or postoperative complications. Histological analysis showed a B-cell lymphoma. After merging the preoperative CT scan with the postoperative MRI and CT scans, the measured error between the planned and the postoperatively measured entry point was 2.24 mm and the measured error between the planned and postoperatively measured target point was 2.33 mm. ::: ::: ::: CONCLUSIONS ::: The RONNA G3 robotic system was used to navigate a Sedan brain biopsy needle to take tissue samples and could be a safe and precise tool for brain biopsy.
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paper_title: Robot-assisted stereotactic brain biopsy: systematic review and bibliometric analysis

paper_content:

IntroductionStereotactic brain biopsy represents one of the earliest applications of surgical robotics. The aim of the present systematic review and bibliometric analysis was to evaluate the literature supporting robot-assisted brain biopsy and the extent to which the scientific community has accepted the technique.MethodsThe Cochrane and PubMed databases were searched over a 30-year period between 1st of January 1988 and 31st of December 2017. Titles and abstracts were screened to identify publications that met the following criteria: (1) featured patients with brain pathology, (2) undergoing stereotactic brain biopsy, (3) reporting robot-assisted surgery, and (4) outcome data were provided. The reference lists of selected studies were also sought, and expert opinion sought to identify further eligible publications. Selected manuscripts were then reviewed, and data extracted on effectiveness and safety. The status of scientific community acceptance was determined using a progressive scholarly acceptance analysis.ResultsAll identified studies were non-randomised, including 1 retrospective cohort study and 14 case series or reports. The diagnostic biopsy rate varied from 75 to 100%, and the average target accuracy varied from 0.9 to 4.5 mm. Use of the robot was aborted in two operations owing to geometric inaccessibility and an error in image registration but no associated adverse events were reported. A compounding progressive scholarly acceptance analysis suggested a trend towards acceptance of the technique by the scientific community.ConclusionsIn conclusion, robot-assisted stereotactic brain biopsy is an increasingly mainstream tool in the neurosurgical armamentarium. Further evaluation should proceed along the IDEAL framework with research databases and comparative trials.
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paper_title: Review of Robotic Technology for Stereotactic Neurosurgery

paper_content:

The research of stereotactic apparatus to guide surgical devices began in 1908, yet a major part of today's stereotactic neurosurgeries still rely on stereotactic frames developed almost half a century ago. Robots excel at handling spatial information, and are, thus, obvious candidates in the guidance of instrumentation along precisely planned trajectories. In this review, we introduce the concept of stereotaxy and describe a standard stereotactic neurosurgery. Neurosurgeons' expectations and demands regarding the role of robots as assistive tools are also addressed. We list the most successful robotic systems developed specifically for or capable of executing stereotactic neurosurgery. A critical review is presented for each robotic system, emphasizing the differences between them and detailing positive features and drawbacks. An analysis of the listed robotic system features is also undertaken, in the context of robotic application in stereotactic neurosurgery. Finally, we discuss the current perspective, and future directions of a robotic technology in this field. All robotic systems follow a very similar and structured workflow despite the technical differences that set them apart. No system unequivocally stands out as an absolute best. The trend of technological progress is pointing toward the development of miniaturized cost-effective solutions with more intuitive interfaces.
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Title: An Overview of Robotics in Functional Neurosurgery

Section 1: Introduction
Description 1: Provide an introduction to the topic of robotic surgery and its application in various surgical fields, with a focus on neurosurgery.

Section 2: An Overview of Robotics
Description 2: Discuss the history and development of industrial robots, their classification, and the types of joints and degrees of freedom relevant to their design.

Section 3: Surgical Robotics
Description 3: Explain different surgical robotic systems, their specific purposes, and the role of master-slave systems in current surgical practices. 

Section 4: Neurosurgery and Robotics
Description 4: Outline the initial uses of robots in neurosurgery, especially in biopsy procedures, and the development of general-purpose neurosurgical robots.

Section 5: Functional Neurosurgery
Description 5: Describe the types of procedures included under functional neurosurgery, the importance of precision and localization, and the role of high-resolution imaging.

Section 6: Target Localization and Reachability
Description 6: Detail the processes involved in reaching intracranial targets, the importance of stereotactic frames, and the challenges faced due to the brain’s consistency and shift during surgery.

Section 7: Error and Its Minimization in Functional Neurosurgery
Description 7: Examine sources of errors in functional neurosurgery, especially during DBS procedures, and discuss strategies and robotic advancements aimed at minimizing these errors.

Section 8: Robots in Functional Neurosurgery
Description 8: Provide an overview of commercially available robots for stereotactic neurosurgical procedures and mention specific systems like Neuromate and ROSA.

Section 9: Indian Groups
Description 9: Discuss the current state of surgical robotic research in India, highlighting key projects and collaborative efforts.

Section 10: Discussion
Description 10: Analyze the challenges and benefits of robotic technology in neurosurgery, cost considerations, and the future potential of robotic systems in this field.

Section 11: Conclusion
Description 11: Summarize the significance of robotics in functional neurosurgery, the potential for widespread adoption, and the future direction of robotic surgical technology.