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Current state-of-the-art and future perspectives of robotic technology in neurosurgery

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Abstract

Neurosurgery is one of the most demanding surgical specialties in terms of precision requirements and surgical field limitations. Recent advancements in robotic technology have generated the possibility of incorporating advanced technological tools to the neurosurgical operating room. Although previous studies have addressed the specific details of new robotic systems, there is very little literature on the strengths and drawbacks of past attempts, currently available platforms and prototypes in development. In this review, the authors present a critical historical analysis of the development of robotic technology in neurosurgery as well as a comprehensive summary of the currently available systems that can be expected to be incorporated to the neurosurgical armamentarium in the near future. Finally, the authors present a critical analysis of the main technical challenges in robotic technology development at the present time (such as the design of improved systems for haptic feedback and the necessity of incorporating intraoperative imaging data) as well as the benefits which robotic technology is expected to bring to specific neurosurgical subspecialties in the near future.

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Authors and Affiliations

  1. Invision Health Brain & Spine Center, 400 International Drive, Williamsville, NY, 14421, USA

    Tobias A. Mattei

  2. Department of Neurosurgery, University of Illinois at Peoria, Peoria, IL, USA

    Abraham Hafiz Rodriguez & Deepak Sambhara

  3. Department of Neurosurgery, The Ohio State University/Wexner Medical Center - The James Cancer Center, Columbus, OH, USA

    Ehud Mendel

Authors
  1. Tobias A. Mattei
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  2. Abraham Hafiz Rodriguez
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  3. Deepak Sambhara
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  4. Ehud Mendel
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Correspondence to Tobias A. Mattei.

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Comments

Kazuhiro Hongo, Matsumoto, Japan

The authors have nicely reviewed historical developments and current state of robotic technology in neurosurgery as well as a comprehensive summary of the currently available systems. As surgery-assisting robotics, there are mainly two types applicable in neurosurgery: stereotactic needle and master–slave manipulator. The stereotactic needle is a good application of robotic technology, while master–slave manipulator has not yet been fully developed in neurosurgical field. The da Vinci surgical system, master–slave type surgical robotics, is currently used in various fields where there is an adequate working space for manipulators such as abdominal, retroperitoneal, and thoracic areas and so on. On the other hand, for neurosurgery where working space is quite limited, further developments in master–slave manipulator might be needed. Another point as the authors described is the haptic feedback which is not available yet. With this function, a surgeon can conduct more accurate surgical procedure. In the future development, however, haptic sensation to the surgeon can be available.

As the technology develops so fast, surgery-assisting robotics becomes available in the near future. Important point, however, is that even with the development of surgery-assisting robotics, surgery should be carried out or controlled by a surgeon, not by robotics, especially in a master–slave manipulator type.

Claudio Tatsui, Houston, USA

Mattei et al. presents a very interesting review of the past, present, and future applications of robotical technology to brain and spinal neurosurgical procedures. Currently, the applicability of robotic technology in neurosurgery is limited and in its infancy, however, as pointed by the authors, development of robotic modular systems can find great applicability when combined to intraoperative imaging in order to perform complex motor tasks through narrow and limited surgical corridors, overcoming the limitations in dexterity of the human hands. In addition, improvements in haptic feedback will allow development of better simulators and will facilitate training in complex and delicate neurosurgical procedures. Obviously, as new technology is introduced, clinical studies have to be performed to evaluate the exact impact in terms of cost and improvement in outcome.

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Mattei, T.A., Rodriguez, A.H., Sambhara, D. et al. Current state-of-the-art and future perspectives of robotic technology in neurosurgery. Neurosurg Rev 37, 357–366 (2014). https://doi.org/10.1007/s10143-014-0540-z

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