SURGICAL ROBOTS IN NEUROSURGERY

M. Kumari

A surgical robot is a robot that allows surgeons greater access to areas under operation using more precise and less invasive methods. They are in most telemanipulators, which use the surgeon's actions on one side to control the "effector" on the other side. Basically they are computer-assisted surgery. Robotically-assisted surgery was developed to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery. The first robot to assist in surgery was the Arthrobot, which was developed and used for the first time in Vancouver in 1983. Intimately involved were biomedical engineer, Dr. James McEwen, Geof Auchinleck, a UBC engineering physics grad, and Dr. Brian Day as well as a team of engineering students. The robot was used in an orthopaedic surgical procedure on 12 March 1984, at the UBC Hospital in Vancouver. Over 60 arthroscopic surgical procedures were performed in the first 12 months, and a 1985 National Geographic video on industrial robots, The Robotics Revolution, featured the device. Other related robotic devices developed at the same time included a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm.

In 1985 a robot, the Unimation Puma 200, was used to place a needle for a brain biopsy using CT guidance.[45] In 1992, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery by Dr. Senthil Nathan at Guy's and St Thomas' Hospital, London. This was the first pure robotic surgery in the world. Also the Robot Puma 560, a robot developed in 1985 by Kwoh et al. Puma 560 was used to perform neurosurgical biopsies with greater precision. Just like with any other technological innovation, this system led to the development of new and improved surgical robot called PROBOT. The PROBOT was specifically designed for transurethral resection of the prostate. Meanwhile, when PROBOT was being developed, ROBODOC, a robotic system designed to assist hip replacement surgeries was the first surgical robot that was approved by the FDA.[46] The ROBODOC from Integrated Surgical Systems (working closely with IBM) was introduced in 1992 to mill out precise fittings in the femur for hip replacement. The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach/rasp.Further development of robotic systems was carried out by SRI International and Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. The first robotic surgery took place atThe Ohio State University Medical Center in Columbus, Ohio under the direction of Robert E. Michler. Examples of using ZEUS include a fallopian tube reconnection in July 1998, a beating heart coronary artery bypass graft in October 1999,[51] and the Lindbergh Operation, which was a cholecystectomy performed remotely in September 2001.The original telesurgery robotic system that the da Vinci was based on was developed at SRI International in Menlo Park with grant support from DARPA and NASA.[53] Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Examples of using the da Vinci system include the first robotically assisted heart bypass (performed in Germany) in May 1998, and the first performed in the United States in September 1999;and the first all-robotic-assisted kidney transplant, performed in January 2009.[54] The da Vinci Si was released in April 2009, and initially sold for $1.75 million. In May 2006 the first artificial intelligence doctor-conducted unassisted robotic surgery on a 34-year-old male to correct heart arythmia. The results were rated as better than an above-average human surgeon. The machine had a database of 10,000 similar operations, and so, in the words of its designers, was "more than qualified to operate on any patient". In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain. In February 2008, Dr. Mohan S. Gundeti of theUniversity of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction. On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm. 
In June 2008, the German Aerospace Centre (DLR) presented a robotic system for minimally invasive surgery, the MiroSurge. In September 2010, the Eindhoven University of Technology announced the development of the Sofie surgical system, the first surgical robot to employ force feedback.[62] In September 2010, the first robotic operation at thefemoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Geršak.
Even various reports and inventions revealed that there are sound development was noticed in Surgical Robot although need much work in Neurosurgery. Several systems for stereotactic intervention are currently on the market for Neurogergery. The NeuroMate was the first neurosurgical robot, commercially available in 1997. Originally developed in Grenoble by Alim-Louis_Benabid's team, it is now owned by Renishaw. With installations in the United States, Europe and Japan, the system has been used in 8000 stereotactic brain surgeries by 2009. IMRIS Inc.'s SYMBIS(TM) Surgical System will be the version of NeuroArm, the world's first MRI-compatible surgical robot, developed for world-wide commercialization. Medtech's Rosa is being used by several institutions, including the Cleveland Clinic in the U.S, and in Canada at Sherbrooke University and the Montreal Neurological Institute and Hospital in Montreal (MNI/H). Between June 2011 and September 2012, over 150 neurosurgical procedures at the MNI/H have been completed robotized stereotaxy, including in the placement of depth electrodes in the treatment of epilepsy, selective resections, and stereotaxic biopsies.
All these instruments and techniques are not enough in the line of Neurosurgery. I think; we need sound software with proper mechanical devices for the surgery and working function of neurons. Applications should be designed for wide spectrum which has ability to understand the automatic nano mechanisms. It should be cost effective for all the levels of community of all continents.



Bibliography

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2.      Kolata, Gina (13 February 2010). "Results Unproven, Robotic Surgery Wins Converts". The New York Times. Retrieved11 March 2010.
3.      Robot-Assisted Surgery: Neurosurgery". Biomed.brown.edu. Retrieved 25 June 2013.
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7.      Tsao, May N. (2012). "International Practice Survey on the Management of Brain Metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control".Clinical Oncology 24 (6): e81–e92.

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