The document discusses the history and current state of robotics in neurosurgery. Early systems from the 1980s-1990s used robotic arms to guide instruments based on preoperative images but lacked real-time imaging. Systems in the mid-1990s like RAMS and Steady Hand introduced real-time imaging, tremor filtering, and force feedback. Current robotic systems can be classified as supervisory-controlled, telesurgical, or shared-control and provide benefits like improved precision, smaller incisions, and eliminating fatigue. NeuroArm is an example of a telesurgical system that allows the surgeon to directly control robotic arms through a workstation providing 3D views, haptic feedback and real-time imaging integration.
A 2019 update on the current role of robotics and simulation in neurosurgery with updates from the recent edition of Youman and Winn's Textbook of Neurosurgery. Videos in the presentation cannot be uploaded but can be viewed from youtube.
A 2019 update on the current role of robotics and simulation in neurosurgery with updates from the recent edition of Youman and Winn's Textbook of Neurosurgery. Videos in the presentation cannot be uploaded but can be viewed from youtube.
Delivery of electrical current to a specific subcortical grey matter target to stimulate a desired group of nerve cells which results in specific modulation the output of the involved neurocirciut.
Pineal gland is essentially an extra axial midline structure lying at the roof of dienchephalon rostral to the quadrigeminal cistern surrounded by important neurovascular structure, occurring in the geometric center of brain with same depth of trajectory had made the surgery in this region a formidable challenge to neurosurgeons, however radical resection must be the goal in selected pathologies, if not pure germ cell tumor.
ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...Anurag Tewari MD
The refractory seizures have significant impact on the quality of life and increase long term neurologic and non-neurologic complications. Implantation of Stereotactic Electroencephalography (SEEG) leads is one of the newer surgical techniques intended to localize seizure foci with higher accuracy than the conventional methods. Most of the commonly utilized anesthetic agents depress EEG waveforms affecting intra operative monitoring during these surgeries. Hence, the anesthetic goals include a stable induction and maintenance with agents which have minimal effect on EEG. This article discusses the peri-operative considerations of multiple anti-epileptic medications, recent advances in anesthetic management, and important post-operative concerns.
Keywords: Anesthesia, epilepsy surgery, intra-operative EEG, intra operative monitoring, refractory seizures, SEEG, seizure foci, stereotactic electroencephalography
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Delivery of electrical current to a specific subcortical grey matter target to stimulate a desired group of nerve cells which results in specific modulation the output of the involved neurocirciut.
Pineal gland is essentially an extra axial midline structure lying at the roof of dienchephalon rostral to the quadrigeminal cistern surrounded by important neurovascular structure, occurring in the geometric center of brain with same depth of trajectory had made the surgery in this region a formidable challenge to neurosurgeons, however radical resection must be the goal in selected pathologies, if not pure germ cell tumor.
ANESTHETIC CONSIDERATIONS FOR STEREOTACTIC ELECTROENCEPHALOGRAPHY (SEEG) IMP...Anurag Tewari MD
The refractory seizures have significant impact on the quality of life and increase long term neurologic and non-neurologic complications. Implantation of Stereotactic Electroencephalography (SEEG) leads is one of the newer surgical techniques intended to localize seizure foci with higher accuracy than the conventional methods. Most of the commonly utilized anesthetic agents depress EEG waveforms affecting intra operative monitoring during these surgeries. Hence, the anesthetic goals include a stable induction and maintenance with agents which have minimal effect on EEG. This article discusses the peri-operative considerations of multiple anti-epileptic medications, recent advances in anesthetic management, and important post-operative concerns.
Keywords: Anesthesia, epilepsy surgery, intra-operative EEG, intra operative monitoring, refractory seizures, SEEG, seizure foci, stereotactic electroencephalography
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Robotic Surgery means computer/ Robotic assisted surgery.
It was developed to overcome the limitations of MAS and to enhance the capabilities of surgeons performing open Surgery History of Robotic surgery
The first robot to assist in surgery was the Arthrobot, which was developed and used for the first time in Vancouver in 1983.[43] 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. A YouTube video entitled Arthrobot illustrates some of these in operation .
Artificial Intelligence & Robotics in Medicine: what does future hold?Vaibhav Bagaria
Talk given in SORC 2017 Mumbai about how the Artificial intelligence and Robotics are likely to shape the future of medicine. How and why the AI and Robots can be a curse and boon at the same time!!!
Introduction_Medical Robotics
Types of medical robots - Navigation - Motion Replication - Imaging - Rehabilitation and Prosthetics - State of art of robotics in the field of healthcare
Neurorobotics and Advances in rehabilitation engineeringBhaskarBorgohain4
Advances in robotics,mechatronics,cyborgs and disruptive technologies for heptics, brain machine interfaces and neurorobotics are bringing a sea change to the field of rehabilitation engineering. Carbon fibre cheetah blades, Bionic arms, c legs are helping the amputees to the extent that amputees can now run in competitive sports at the level of summer Olympics.
On July 11, 2000, the Food and Drug Administration (FDA) approved the first completely robotic surgery device, the da Vinci surgical system from Intuitive Surgical (Mountain View, CA).
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. • The world's first surgical robot was the 'Heartthrob', which was developed and
used for the first time in Vancouver, BC, Canada in 1983.
• The very first surgical robot was used in orthopaedic surgical procedure on
March 12, 1983, at the UBC Hospital in Vancouver.
• 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
3. • The first robotized operating microscope for neurosurgical applications was the
MKM system introduced by Zeiss in 1993.
• The system consisted of a robot arm holding different tools, including a
microscope head. The working radius and the dynamics of the MKM were
relatively restricted, so it was mainly applied for procedures of the frontal skull
base.
• In 1995, Giorgi and colleagues attempted another robotized solution for an
operating microscope. They attached a microscope head (Möller- Wedel VM
500) to an industrial robot arm. The microscope could be directed by a joystick
placed where conventional microscope handles are typically located.
• In a second generation of the device, the same authors integrated 3
synchronized charge coupled device cameras around the microscopes front lens.
This allowed tracking of infrared markers in the surgical field.
4. • 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
5.
6. • Robotics provides mechanical assistance with surgical tasks, contributing greater
precision, accuracy and allowing automation and augment surgical performance,
by steadying a surgeon’s hand or scaling the surgeon’s hand motions.
• work in tandem with human operators to combine advantages of human thinking
with capabilities of robots to provide data, optimize localization on a moving
subject, to operate in difficult positions, or to perform without muscle fatigue.
• Surgical robots require spatial orientation between the robotic manipulators and
the human operator, which can be provided by Virtual Reality environments that
re-create the surgical space and enables surgeons to perform with the advantage
of mechanical assistance but without being alienated from the sights, sounds, and
touch of surgery.
7. • virtual reality (VR) is a computer-generated 3-D environment that provides real-
time interactivity for the user.
• On a computer, VR is experienced primarily through 2 of the 5 senses: sight and
hearing. The simplest form of VR is a 3-D image that can be interactively
explored with a personal computer, usually by manipulating keys or the mouse
so that the content of the image moves in some direction or zooms in or out.
• More sophisticated systems involve the use of a headset as display and haptic
devices.
8. • An absolute virtual environment requires sensory information be processed at
speeds equal to or faster than the human brain can perceive it to eliminate the
delay between sensory input and output.
• For instance, with haptics, the refresh speed must be 500 Hz, or ,2 milliseconds, for
humans to perceive the feedback as continuous. If the refresh speed is any slower,
the operator will be able to feel the pauses between information updates.
• Another challenge is the difficulty of accurately modeling human tissue in VR;
current 3-dimensional models derive the surface texture of the brain and replicate
it, which means that a virtual brain does not quite resemble the real thing
• ongoing challenges of both VR and surgical robotics are the high cost of technology
development, the complexity of re-creating human senses and the limitations of
computer processing
9. • One of the main advantages of computer elaboration, and particularly of a VR
environment, is that it allows anatomic, metabolic, and functional data from
different sources to be combined (or registered together) in the same 3-D space.
• This 3-D VR representation can be examined in detail, shared and discussed with
others, and related precisely to physical reality
• Haptics is an expanding field that focuses on replicating human touch. The
discrepancy between human touch and the sensations provided by haptic
technology is significant, but the field of haptics is constantly incorporating more
complex understandings of human touch into new products.
• Haptics technology is taking advantage of different mechanical and electrical
developments to apply forces, vibrations, motions, or even weak electric shocks to
provide a virtual sense of touch.
10. • Neurosurgery was one of the first organ systems in which robotic surgery was
introduced, due to the high precision that was required to localize and manipulate
within the brain, and the relatively fixed landmarks of the cranial anatomy.
• Robots today have found applications in neurosurgical practice for guiding
instruments along predefined trajectories or providing physical guidance during
stereotactic procedures in brain and in spinal operations.
• Furthermore, robotized C arms are somewhat established as tools in intra
operative fluoroscopy. Experimental applications include positioning of trans
cranial magnet stimulation stimulators and robotized brain retractors.
11. Programmable Universal Machine for Assembly industrial
robot (1985 – Advanced Research & Robotics,Oxford)
• The PUMA was the first time a robot was ever used for neurosurgery. The
surgeon inputted the x-y coordinates on a probe based on a preoperative image
of an intracranial lesion.
• He then used programs which calculated the stereotactic coordinates (frame-
based), which then guided the drilling of the biopsy. This was possible with the
introduction of a Cartesian robot (Compass International, Rochester, MN) which
placed a stereotactic head frame around the patient’s head.
• It then uses fiducial markers to record an image of the patient’s brain. The
device lacked safety features, but the potential of this technology excited
scientists all over. Robotics became increasingly used in frame-based
stereotactic techniques.
12. NeuroMate (1987 - Integrated Surgical Systems, Sacramento,
CA)
• NeuroMate was the first neurorobotic device to be approved by FDA, as well
as the first to be commercially available.
• Preoperative imaging helped the surgeon plan the procedure, and a passive
robotic arm was able to perform limited tasks in over 1000 procedures.
• However, this technology still relied on preoperative images to position the
robot, and was prone to errors when the brain shifted.
13. Minerva (1991 University of Lausanne, Lausanne, Switzerland)
• first system to provide image guidance in real-time, allowing the surgeon
to change the trajectory as the brain moved, resulting in frameless
stereotaxy.
• Important because the structure of the brain and fiducial markers was
assumed to be in the same position before. The position of surgical tools
in relation to intracranial imaging could now be seen.
• Intraoperative imaging can compensate for these shifts and
deformations. This was accomplished by placing a robotic arm inside a
computed tomography (CT) scanner, and improvements in
neuronavigation tools. The implementation of CT greatly improved 3-D
localization, improving accuracy.
• The system also improved safety features which were lacking on the
pervious models. However, the system was still limited because it could
only perform single dimension incursions, and the patient had to be
inside the CT system. As a result, the project was discontinued 2 years
later in 1993
14. Robot-Assisted Microsurgery System (1995 NASA, Washington
• RAMS was the first robotic system that resembled present day robotic surgical
suites. It was the first system that was compatible with magnetic resonance
imaging (MRI), as it was able to filter out electromagnetic fields that distorted
images.
• Intraoperative imaging could now be fully integrated into the operating room
unlike the Minerva. The system was based on master-slave control with 6 degrees
of freedom, allowing 3-D manipulation, and not just limited to stereotactic
procedures.
• Along with adjustable tremor filters and motion scaling (dexterity enhancements),
it was able to improve the precision of the surgeon by 3-folds, and the benefits of
robotic surgery were beginning to be seen. The systems currently on the market
are surprisingly very similar in capabilities to RAMS.
15. The Steady Hand System (1995 –John Hopkins University,
Baltimore)
• Along with RAMS, it defined the new standard of robotic systems in
microsurgery.
• The new wave of systems all enhanced dexterity by filtering out tremor and
featured the master-slave interface.
• The main improvement over RAMS was the fact that this system could also
detect force in the handles. This was important because surgeons had no idea
how hard they were pressing against a surface before.
• Despite its great improvements, it was somewhat surprising that this system
was never used in clinical applications.
16. NeuRobot (Shinshu University School of Medicine, Japan)
• The NeuRobot was the first system that performed tele controlled surgery
through an endoscope.
• The 10-mm endoscope contained twin tissue forceps, a camera, a light source,
and a laser.
• The investigators removed a tumor from a patient, and found the system to be
more accurate and less invasive then traditional methods
• The SpineAssist Robot (Major Surgical Technologies, Haifa, Israel)….. The
sodacan sized SpineAssist Robot was the first FDA approved robotic system for
spinal surgery.
• The device is guided by imaging and is placed directly on the spine for more
accurate tool placement and less invasive surgery.
17. Early History
1980s-Researches hit a limit for advancing traditional neurosurgery
The magnification of surgery is too small for human surgeons
1985-Puma Programmable Universal Machine for Assembly industrial
robot (Advanced Research & Robotics, Oxford, CT)
The surgeon inputs x-y coordinates and uses programs which calculated
the stereotactic coordinates in frame based surgeries
1987-Neuromate (Integrated Surgical Systems, Sacramento, CA)
Uses preoperative images and passive robotic arms
18. History (continued)
1991-Minerva (University of Lausanne, Lausanne, Switzerland)
Used real time images from a CT scan allowing the surgeon to
change markings during the procedure
1995-Robot-Assisted Microsurgery System (NASA, Washington DC)
Uses MRI images during surgery in order to give surgeon a clear
picture of the brain
1995-The Steady Hand System (John Hopkins University, Baltimore,
MD)
Detects the amount of pressure a surgeon uses
2000s- NeuRobot (Shinshu University School of Medicine, Matsumoto,
Japan)
Endoscopic
21. Current Technology
• The neurosurgical robot consists of the following components at the most basic
level: robotic arm, feedback sensors, controllers which instructs the robot (end-
effector), a wireless localization system and a data processing center (the brain).
• The end-effector is able to control the robotic arm and use tools such as a probe,
endoscope, or retractor. The tool can usually be manipulated with 6 degree of
freedom.
• Sensors provide the surgeon with the necessary feedback from the surgical site,
which is processed by the computer, returning information such as the location of
a tool within a site.
22. • In the case of robotically-assisted minimally-invasive surgery, instead of directly
moving the instruments, the surgeon uses methods to control the instruments;
either a direct telemanipulator or through computer control.
• A tele manipulator is a remote manipulator that allows the surgeon to perform
normal movements associated with the surgery whilst the robotic arms carry
out those movements using end-effectors and manipulators to perform the
actual surgery on the patient.
• In computer-controlled systems surgeon uses a computer to control robotic
arms and its end-effectors.
• One advantage of using the computerised method is that the surgeon does not
have to be present, but can be anywhere in the world, leading to the possibility
for remote surgery.
23. most important advantages are
• the ability to perform surgery on a smaller scale (microsurgery),
• increased accuracy and precision (stereotactic surgery),
• access to small corridors (minimally invasive surgery),
• ability to process large amounts of data (image-guided surgery),
• the ability for telesurgery, and
• deducing the surgeon’s physiological tremor by 10-folds
• Eliminates fatigue
24. Surgical robots can be classified into three broad categories
on the basis of how the surgeon interacts with them
1. Supervisory-Controlled Systems….procedure is planned
beforehand and the surgeon specifies the motions which the robot goes through.
The robot performs exactly the same motions automatically during the operation,
with the surgeon watching to ensure that there are no errors
25. 2. Telesurgical Systems
• The surgeon directly performs the operation with a haptic interface. Using a
force feedback joystick control, the surgeon carries out motions that the surgical
manipulator replicates.
• The surgeon is able to see inside the cranial framework with real-time
intraoperative imaging
26. 3. Shared-Control System
• The robot undergoes steady-hand manipulations of the surgical instrument while
the surgeon controls the whole procedure. The surgeon and robot are jointly
performing tasks
27. Current State
• 1. Supervisory-Controlled Systems
– Surgeon performs motion before surgery and robot repeats motion
• 2. Telesurgical Systems
– Surgeon uses haptic interface to control robot
• 3. Shared-Control System
– Surgeon and robot share the surgery
28. NeuroArm (2006 – University of Calgary, Alberta, Canada)
• The $30 million NeuroArm project packages all the features that a neurosurgeon
would need to directly manipulate any intra-cranial function
• Designed based on biomimicry, the controller’s hand movements (master) are
replicated by robotic arms (slave) which hold surgical tools.
• The NeuroArm comprises 2 arms, each with 7 degrees of freedom, and a third
arm with 2 cameras which provides the surgeon with a 3-D stereoscopic view.
• NeuroArm is able to carry out microsurgical techniques and soft tissue
manipulations such as biopsy, microdissection, thermocoagulation, blunt
dissection, grasping of tissue, cauterizing, manipulation of a retractor, tool
cleaning, fine suturing, suction, microscissors, needle drivers, and bipolar forceps.
• All the tools are exchanged at the end-effector, which also provides haptic force
feedback to the surgeon.
• The 3rd component of the NeuroArm which makes it unique is the workstation.
29. • to replicate the surgical arena, the workstation provides the surgeon with 3 areas
of feedback: sound, sight, and touch.
• The surgical microscope (binoculars) give stereoscopic views of the brain’s complex
folds, while MRIs and robotic sensors create a 3-dimensional map of brain for the
surgeon on the displays. The microsurgical tools and real-time MRIs increase the
accuracy of the surgeon 1000-folds.
• The workstation includes a computer processor, hand controllers for robotic
arms, joystick controller for cameras and lights, 3 different displays and recorders.
• Video Display presents a 3-D stereoscopic view to give surgeon sense of depth.
• MR Display shows the patients MR scan and tracks the location of the tool in real-
time (pre, post, and intraoperative).
• Control Panel Display shows operation status, force feedback, and control
configuration.
30. • NeuroArm also incorporates safety features such as filtering out hand tremors,
fail safe switches that prevent accidental movements, and force sensors which
provide the sense of touch.
• With a combination of intraoperative MRIs and fiducial markers, the neuroArm
can also program the boundaries of the surgical field during presurgical
planning.
• The materials used to build the components have been thoroughly tested for
MR compatibility. The robotic arms are made out of titanium and polyether
etherketone (plastic polymer) because they have the least image distortion.
31. • NeuroArm evolved as a potential method for improving the integration of
imaging with microsurgery and stereotaxy.
• It has the potential to perform surgery within the bore of a high-field magnet,
which would allow high quality intra-operative imaging without interrupting the
rhythm of surgery.
• Surgeons will be able to see and manipulate imaging data from the remote
workstation of neuroArm without compromising sterility or unduly prolonging
the surgical procedure
• NeuroArm is a teleoperated magnetic resonance compatible image-guided
robot
32. The NeuroArm workstation is remote from the operating room.
(Inset)…the neuroArm robot with bipolar forceps in the right
manipulator and suction in the left.
One of the most unique features of neuroArm is its sensory immersive
workstation. This workstation allows the surgeon to access the surgical site
remotely and provides some of the sensations of surgery through visual, aural,
and haptic technologies
33. Telementoring and Telesurgery (The Socrates System)
• The Socrates system the first
telecollaboration system to be approved
by the FDA, and was first used in Canada
when a neurosurgical center in Halifax,
Nova Scotia tele mentored a smaller
center in Saint John, New Brunswick.
• the mentor had direct control of the
endoscope camera, real-time
neuronavigation data, and two-way video
and audio communications with the
operative site. He was even able to
control the robotic arm, AESOP, if
necessary to give him full control of the
surgical field in the remote site.
34. • It is called telementoring when the local surgical team is performing the
operation with an expert mentor watching through the interface for errors.
• It is called telesurgery when the mentor performs the surgery directly with
a surgical team watching to learn techniques (and as a safety precaution
should mechanisms fail). Although the mentors have full control of the
robotic arm’s movements during telesurgery, the surgeons in the remote
area could override the mentor’s control as a safety feature.
35. • The future of neurosurgery will include a system which can perform a wide
spectrum of neurosurgical procedures, an increasing usage of telementoring
and telesurgery, improvements in artificial intelligence, and virtual reality.
• The future of neurorobotics will see robots with ambidextrous abilities, more
degrees of freedom, kinesthetic feedback, and a more user-friendly interface.
• Greater integration of artificial intelligence and nanotechnology will soon
create surgical procedures that cannot be done without it, revolutionizing
neurosurgical practice