Neurosurgeons at HSK Hospital in Wiesbaden, Germany have used Mazor Robotics' Renaissance spine surgery system to conduct the first robot-guided brain surgery procedures. HSK was one of the first medical centers in the world to begin using robotic technology for spine surgeries. Mazor did not reveal any details about its brain surgery application, or what kind of brain surgery procedures the hospital performed.
Mazor's Renaissance system and its predecessor, SpineAssist, have been used in several thousand spine surgeries, including procedures for scoliosis and other complex spinal deformities, osteotomies, and biopsies. The company says that its technology is also applicable to brain surgery for uses such as biopsies, placements of shunts, and placement of neurostimulation electrodes, such as those used for deep brain stimulation.
The first brain surgery assisted by robots has been performed at HSK Hospital in Wiesbaden, Germany using Mazor Robotics' Renaissance robotic guidance system for spine surgery. (Source: Mazor Robotics)
About 25,000 brain biopsies are performed in the US every year. About half of surgeons who currently use Mazor's Renaissance and SpineAssist robots for spinal surgeries are neurosurgeons, who often also perform brain surgery. Mazor expects that its spine surgery technology will bring similar benefits to brain surgery as it does to spine surgery: increased patient comfort, improved surgical accuracy, and a less invasive approach. Robotic spine surgery is considered to be especially useful where there are line-of-sight challenges, such as with minimally invasive surgeries or complex anatomy.
The Renaissance system, which has an accuracy of 1mm, functions primarily as a guide for surgical tools and implants. It consists of a workstation, software, a guidance unit, and several mounting options. There are four basic steps to its operation for spine surgery. First, surgeons conduct preoperative planning by uploading the patient's CT scan. Using this, they create a preoperative blueprint of the ideal surgery for that particular patient in a virtual 3D environment. This is usually done on a PC. The robot is then rigidly attached to the patient's spine via a mounting platform. This assures the maximum possible accuracy during surgery.
The 3D surgical blueprint is synchronized with the mounting system using two fluoroscopic images of a fiducial array, somewhat similar to the fiducial arrays used for the same purpose in printing and machine vision. Once that's completed, the operation can begin. (Watch a video showing how it works below.)
The Renaissance system has been cleared in the US and Europe for spinal surgery. Now, regulatory clearance for Mazor's brain surgery application is pending in both regions. When completed, Mazor expects to make the brain application available as an add-on to the Renaissance system in early 2013.
Squeamishness aside, I can see a huge advantage to sitting in an office with multiple 3d views, allowing for accurate placement planning. Now, to find a Dr. who is also geeky enough to master the software. Absent that, you can put Dr. and geek side by side at that stage.
The alternative is depending on a surgeons skill in visualizing the path of the drill thru bone. Good luck figuring out which Doctor is going to be best at this, on the day you are under the knife. When it comes to spinal cords, you don't ever want to miss, which probably means doctors currently err on the side of caution. As a natural consequence, they may not even try to place the screws as optimally as might be done with this.
Well, I think it's almost a robot in the sense that the software is controlling the robotic motors at the time of surgery. You could say it's the same as the "robots" that build cars, right? But certainly no artificial intelligence or autonomy as the headline might imply. The doctors probably press a "next" button (like a remote control) to move to the next position that was pre-programmed by the doctors earlier.
Personally I'm more impressed with the imaging systems. Maybe that's "old" technology, but I didn't know they could so perfectly create 3D models of live patients and then recalibrate positioning (matching each vertebra) once the framework is attached to the patient. Cool!
But it was hard to watch. I'm definitely going to start taking better care of my back!
OK - here is something that sticks in my craw. So many things that are simply remote control get the "robot" label.
Regardless of the fact that this machine is so technically advanced and a fantastic tool for surgeons......my question is "does it truly operate as a robot? - or is it remote control?" Looks to me like it might actually fit the robot definition??
I have to admit that I, too, am a little squeamish about this. The sentence that caught my eye was: "...the robot is then rigidly attached to the patient's spine via a mounting platform." I'm troubled by the words "rigidly attached" and "mounting platform." In conventional back surgery, do doctors rigidly attach some kind of platform? How does it attach? And if we're talking about brain surgery, what does it rigidly attach to there? The skull? On second thought, please don't tell me. I don't want to know.
As a mechanical and optical servo guy, it started me thinking about what I would have to change to make my systems be so reliable and TOTALLY avoid the kind of motions and errors that a surgical control device must have total control over. It's scary. Hats off to the Germans for getting their feet wet in this arena. I am sure there are many following close behind. Awesome!
I think the discussion of relative risk is an interesting one: I'd love to see some comparative statistics. A robot is a lot simpler than a human, so there's less to go wrong, and also much more predictable. Plus a human brain programmed it, so one would think there's less likelihood of error, especially if medical apps use the kind of software reliability controls that military apps do. A human might have had less sleep, a secret drinking habit, or an argument with his/her spouse that morning before surgery, any of which could cause errors. I suspect there's more likelihood of error with the human, as Chuck has implied elsewhere in his comments about human "rogue" drivers vs predictable robot drivers. OTOH, this robot is under the control of a human all the time, as Beth points out.
Jennifer, I totally agree with you. There are so many different things that can go wrong like Naperlou stated the robot contains software this adds the risk of software bugs. Then there is hardware with failure risks due to things like counterfeit components just to name one. I have spend most of my career designing mission critical circuits for things like aircrafts where we design with the intent or desire to never have failures but we know in reality failures occur.
As cool as this is, I would be afraid of some sort of malfunction on the part of the robot. Building my car and doing dangerous work so soldiers don't have to is one thing, but tinkering with my brain is quite another. I'm all for robotic advancement, but I draw the line here. If the time comes, I'm leaving my brain in the hands of a properly trained, human, surgeon.
Ann, I know this is a great step forward in surgery. On the other hand, I am always a bit squeamish about such things when I think about them.
It does get a little dicey when you realize that this is software controlled. I know that is essential, but it does give one pause. Of course, the traditional way relied on the human brain, and didn't that program the software? Well, I guess we just need to get used to it.
One thing this does remind me of is the medical robot in the Star Wars movies. Future, here we come.
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