Merging machines with microsurgery: clinical experience with neuroArm

Clinical article

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Object

It has been over a decade since the introduction of the da Vinci Surgical System into surgery. Since then, technology has been advancing at an exponential rate, and newer surgical robots are becoming increasingly sophisticated, which could greatly impact the performance of surgery. NeuroArm is one such robotic system.

Methods

Clinical integration of neuroArm, an MR-compatible image-guided robot, into surgical procedure has been developed over a prospective series of 35 cases with varying pathology.

Results

Only 1 adverse event was encountered in the first 35 neuroArm cases, with no patient injury. The adverse event was uncontrolled motion of the left neuroArm manipulator, which was corrected through a rigorous safety review procedure. Surgeons used a graded approach to introducing neuroArm into surgery, with routine dissection of the tumor-brain interface occurring over the last 15 cases. The use of neuroArm for routine dissection shows that robotic technology can be successfully integrated into microsurgery. Karnofsky performance status scores were significantly improved postoperatively and at 12-week follow-up.

Conclusions

Surgical robots have the potential to improve surgical precision and accuracy through motion scaling and tremor filters, although human surgeons currently possess superior speed and dexterity. Additionally, neuroArm's workstation has positive implications for technology management and surgical education. NeuroArm is a step toward a future in which a variety of machines are merged with medicine.

Abbreviations used in this paper:iMRI = intraoperative MRI; KPS = Karnofsky Performance Status; OR = operating room.

Article Information

Address correspondence to: Garnette Sutherland, M.D., University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada. email: garnette@ucalgary.ca.

Please include this information when citing this paper: published online December 14, 2012; DOI: 10.3171/2012.11.JNS12877.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A diagram of a neuroArm manipulator showing many of the internal components. The degrees of freedom are labeled. The inset highlights the tool holder.

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    An overview of the neuroArm system.

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    Photograph of the neuroArm showing the sterile drapes covering the neuroArm manipulators. The right manipulator displays the tool holder assembly and attached bipolar forceps. The left manipulator shows penetration of the sterile drape by the upper and lower tool holders and tool roll gear.

  • View in gallery

    Photographs showing neuroArm in use. The main image displays the workstation relative to the OR. The surgeon operates the workstation's haptic hand controllers, and the assistant surgeon is stationed opposite neuroArm. The inset shows the neuroArm manipulators and the assistant surgeon resecting a pilocytic astrocytoma located in the right cerebellum.

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    Chart showing an overview of Phase I clinical studies divided by integration into 1.5-T or 3.0-T iMRI environments.

  • View in gallery

    Hazards related to the introduction of robotics into neurosurgery. Described are the causes of the hazard, the control used to mitigate the risk, and the remaining challenges related to the hazard.

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