Merging machines with microsurgery: clinical experience with neuroArm

Clinical article

Garnette R. SutherlandDepartment of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Alberta, Canada

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Sanju LamaDepartment of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Alberta, Canada

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Liu Shi GanDepartment of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Alberta, Canada

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Stefan WolfsbergerDepartment of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Alberta, Canada

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Kourosh ZareiniaDepartment of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Alberta, Canada

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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.
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