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Kathrin Machetanz, Florian Grimm, Thomas V. Wuttke, Josua Kegele, Holger Lerche, Marcos Tatagiba, Sabine Rona, Alireza Gharabaghi, Jürgen Honegger, and Georgios Naros

implantation of electrodes for SEEG in the neurosurgical department of the University of Tuebingen between 2017 and 2020 by a single neurosurgeon (G.N.). Twelve patients (mean age 23.2 ± 17.0 years [range 2.8–56.5 years], 9 female) underwent frame-based surgery (frame group) and 15 patients (mean age 26.5 ± 15.7 years [range 5.9–57.9 years], 8 female) underwent a robot-assisted surgery (ROSA One, Zimmer Biomet; robot group). The frame-based implantations were performed in the months prior to the installation of the robotic unit in September 2018. Notably, 10 (37%) of 27

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Luciano Furlanetti, Jonathan Ellenbogen, Hortensia Gimeno, Laura Ainaga, Vijay Narbad, Harutomo Hasegawa, Jean-Pierre Lin, Keyoumars Ashkan, and Richard Selway

frame-based techniques to frameless devices and robot-assisted surgery. The integration of robotics and intraoperative imaging has provided further refinement of the technique, increasing performance and minimizing the number of surgical steps prone to human error. 12 During the last 30 years, diverse robotic systems have been developed for stereotactic neurosurgery and experience has accumulated with several clinical indications, i.e., tumor biopsies, stereoelectroencephalography, radiosurgery, and DBS surgery, although almost exclusively in adult patients. In the

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Changhan Jun, Madhav Sukumaran, and Jean-Paul Wolinsky

Resection of a giant pre-sacral schwannoma originating from the right S2 nerve in a 22-year-old woman illustrates the potential for robotic surgery. The da Vinci Robot Surgical System facilitates visualization deep in the pelvis and allows for bimanual wristed instrument control to dissect the tumor from surrounding sensitive structures. Neurostimulation to identify critical nerves is possible and complete resection of the tumor can be achieved. There were no complications, she remained neurologically intact, the estimated blood loss was less than 75 ml, the total hospital stay was 3 days, and she returned to work within 2 weeks of her operation. In select patients, robot-assisted surgery may have advantages.

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Xiaoguang Han, Wei Tian, Yajun Liu, Bo Liu, Da He, Yuqing Sun, Xiao Han, Mingxing Fan, Jingwei Zhao, Yunfeng Xu, and Qi Zhang

/Renaissance robot varies widely, and one study even demonstrated significantly reduced accuracy with the robot-assisted surgery (85%) compared to that with the fluoroscopy-guided technique (93%). 12 The lower accuracy of the robot-assisted surgery may have been attributable to the reduced working volume of the robot, which makes it less able to withstand reactive forces and leads to movement of the robotic arm relative to the patient. 17 Another robot used in spinal surgery is the ROSA robot (MedTech), which comprises a patient-side cart (bearing a robotic arm with 6 degrees of

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John Y. K. Lee, Bert W. O'Malley Jr., Jason G. Newman, Gregory S. Weinstein, Bradley Lega, Jason Diaz, and M. Sean Grady

pathological entities, such as a meningioma, or if an inadvertent durotomy occurs during extradural dissection, achieving a watertight closure of the dura mater in such a deep and narrow working channel is limited with current microscopic and endoscopic techniques. These considerations have led our group to explore an alternative approach. The use of robot-assisted surgery has gained significant support in multiple surgical specialties, including cardiac surgery, urology, obstetrics, gynecology, and, most recently, minimally invasive head and neck surgery. Proponents of

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Karthik Madhavan, John Paul G. Kolcun, Lee Onn Chieng, and Michael Y. Wang

Czech word “robota,” meaning “forced labor.” 48 It probably referred to tasks performed by very simple automated devices. Sixty-four years later, the first robot-assisted surgery was performed in 1985 by Shao et al., using the PUMA 200 robot. 50 These advances aided the development of laparoscopic surgery in 1987. 21 There was limited acceptance of robotics in neurosurgery until the advent of minimally invasive surgery (MIS), which is highly dependent on fluoroscopy (spine) and navigation (cranial). 26 Because navigation or fluoroscopy could establish a safe

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Dorian Chauvet, Stéphane Hans, Antoine Missistrano, Celeste Rebours, Wissame El Bakkouri, and Guillaume Lot

Obstet Gynecol 19 : 331 – 336 , 2007 2 Ahn JY , Kim SH : A new technique for dural suturing with fascia graft for cerebrospinal fluid leakage in transsphenoidal surgery . Neurosurgery 65 : 6 Suppl 65 – 72 , 2009 3 Amelot A , Trunet S , Degos V , André O , Dionnet A , Cornu P , : Anatomical features of skull base and oral cavity: a pilot study to determine the accessibility of the sella by transoral robotic-assisted surgery . Neurosurg Rev 38 : 723 – 730 , 2015 4 Carrau RL , Prevedello DM , de Lara D , Durmus K , Ozer E

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Hamed Azarnoush, Samaneh Siar, Robin Sawaya, Gmaan Al Zhrani, Alexander Winkler-Schwartz, Fahad Eid Alotaibi, Abdulgadir Bugdadi, Khalid Bajunaid, Ibrahim Marwa, Abdulrahman Jafar Sabbagh, and Rolando F. Del Maestro

forceps to perform blunt nondamaging dissection around the circle of Willis in robot-assisted surgery, the maximum force found was 2.04 N. 18 A lower peak force of 1.35 N was measured in another study when bipolar forceps were used to do cadaveric brain dissections. 13 In a subsequent study by this group involving robot-assisted surgery, the maximum forces used by 2 surgical instruments, bipolar forceps and a suction device, during the resection of 4 human tumors by a single surgeon was 1.86 N. 21 The majority of the forces measured in the neurosurgeon group in our

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Shawn M. Vuong, Christopher P. Carroll, Ryan D. Tackla, William J. Jeong, and Andrew J. Ringer

was used by neurosurgeons to robotically guide placement of brain biopsy needles. Subsequent types of surgical robots introduced in the 1990s were primarily experimental. However, this changed with the development of the first da Vinci surgical robotic system (Intuitive Surgical) in 2000, the first system approved by the FDA for general laparoscopic surgery. 48 Due in large part to the da Vinci robotic system and adoption of robotically assisted surgery programs, significant strides were noted in urological, gynecological, and head and neck surgery in the 2000s. 48

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Faris Shweikeh, Jordan P. Amadio, Monica Arnell, Zachary R. Barnard, Terrence T. Kim, J. Patrick Johnson, and Doniel Drazin

increasingly used in the field, it will be important to provide evidence that the use of robot-assisted surgery is superior to freehand or image-guided methods in patient outcomes and cost-effectiveness. 35–37 Many factors specific to surgery in the spine make the use of robotic technology ideal for improvement of techniques and outcomes. Placement of screws and implants can be assisted by robotic localization for accuracy and precision. 36 , 39 The proximity of blood vessels and nerve roots to the bony structure creates the possibility of severe postoperative