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.
This is a great accomplishment and will likely pave the way for all kinds of robot-guided surgeries, all of which, when perfected, can help minimize invasive procedures and improve patient recovery and care. The key challenge will be getting patients to understand that the robot isn't actually performing the surgery--it's just another tool in the surgeon's medical bag.
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.
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.
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.
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 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!
Warren, I'm also becoming really curious about the reliability stats for these surgical robots and how one a) engineers them and b) tests them for what must be ridiculously low error rates, like p = 0.0001, or something (to borrow from the world of statistical significance measurement). Does anyone know?
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.
Chuck, I had the same response to those words. Worse, I watched the video. Yecchh. However, most of us have not had to think about these details before, unless we've had spine surgery. I suspect the whole surgical process is equally gruesome whether it's being done directly or indirectly with robotic help.
I'm going to have to disagree with you Jennifer. After seeing somebody go through brain surgery, I think this would be a big help. First of all, I would imagine that you could use smaller instruments, and hence the hole they have to cut in your skull could be minimized. (It's not necessarily a drilled hole, but rather a 6" diameter flap that could be cut out. Next, the movements can be finer than a human would be able to do, meaning that they would be able to leave more "good" brain tissue intact, reducing likely damage. Finally, while a computer can crash, a surgeon can get the hiccups!
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.
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??
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!
Hi, I can see that there will be many advantages for using robotic surgery.
1 There must be instances where the surgeon's hands are simple too big to manipulate instruments in a tiny space. Perhaps they just limit vision.
2 As a teaching tool it is easier to include students simply by adding a few monitors.
3 Now this is a big one... Surely the costs of surgery can be reduced by improving efficiency and speeding up surgical procedures. Surgeons can adopt a more comfortable posture and of course perform more operations per day. recovery times can be reduced through less invasive procedures too.
There are plenty of upsides that make these machines look well worth their undoubtedly high cost.
Before I would trust my back to the robot, I would want to know a lot more about the whats and the hows of the robot. And I think that is precisely the area where much more information is required. I would want to understand the process of robotics surgery offered by the center and the relationship between my back, the surgeon, the robot, and the geek! as someone mentioned here. I think key to proliferenace of these robots and underlying technics is far more dissemination of information compared with what we see.
I read about a robotic system for radio therapry of lung cancer. I think it is called the RoboKnife. Given that when we breath the position of the tumor in the lungs changes, a special room is equipped with sensors to fire the x-ray at the right moment. Furthermore, there are many angles where firing the x-ray is OK as it causes minimal damage to surrounding tissue and others where firing is prohibited because it can cause damage to spinal cord or other sensitive tissues. Working out the plausible angles was a geeks job that would be done before the administration of the therapy.
I think I would trust that system if I needed to undergo radio therapy. Information is what companies have to provide to receive trust. This means all the different sorts of data and hows and what that people have referred to here. What is disappointing about the Mazer system is that it comes with no information, also on their website. This makes the robot a claim rather than a tool and I would not trust a claim.
You're not alone in wishing there was more information about the Mazor Robotics surgical system, britelite. As with the Da Vinci surgical robot, the proof will be in the pudding (a perhaps unfortunate analogy considering the topic), meaning, successful surgery rates over time.
This technology is very interesting; 1mm accuracy is pretty good! Considering most 3D printers only offer twice that resolution.
I think it is just a matter of time before robots will be performing the harder surgeries to remove risk. Humans make errors, where machines don't, especially if the computerized machine is monitored by a human.
Compare it to a CNC lathe using a good quality CAD-CAM software, not only can you find faults before you actually perform the procedure, most machines using the proper software won't let the operator proceed if any problems arise.
Not just that a machine like this will do the same job faster and with more accuracy.
Another thing worth comparing this to would be a torch, yup... a torch. Look at the way Abasing torches where made in the past, no arrestors, no safety, just fill a pot with fuel and light the end with the hope nothing blows up. Today's torches can be used by anyone without having to worry about getting killed, that all said, we are always evolving and making things safer.
Regardless this technology will help people.
So how much longer before we no longer need people to make things or fix things? I think this world is going to be a very different place in 60 years.
Ann--This technology blows me away and proves that I'm 168 pounds of rompin, stompin coward. I definitely feel the pre-operative process is state-of-the-art and very useful even if the robotic process is not used and dependent upon (hopefully) a very capable surgeon. I can also see that 1 MM is absolutely required because no errors are permissible. The tough part--securing the "bridge" to the patient's spine. This is where I feel the greatest errors, if any, can be made. Great post.
Incredible stuff. These are surgeon-guided and robot aided machines if I understand it correctly (hand tremors get filtered out) - making it both smart and accurate. This would have been science fiction 25 years ago.
bobjengr, glad you liked it. It gives me the willies, too. However, it's also true that most of us have not had a chance to examine what happens in this kind of surgery before, unless we had to learn about it for our own upcoming date with a surgeon, or perhaps a loved one's. If we had, that would have acquainted us with many of the same gory details. So I suspect that much of the squeamishness commenters have expressed has more to do with the surgery itself than whether it's a robot or a human manipulating the surgical tools.
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