Robot-assisted neurosurgery indications [Neurosurgery Wiki]

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====== Robot-assisted neurosurgery indications ======
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[[Robotic]]-assisted surgery (RS) has progressively emerged as a promising [[technology]] in modern thoracolumbar [[spinal surgery]], offering the potential to enhance accuracy and improve clinical outcomes
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[[Robotic pedicle screw placement]].
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[[Procedure]]s utilizing [[robotic]] assistance during a 24-mo period were retrospectively analyzed and classified as [[stereotactic]] or [[endoscopic]] based on the mode utilized in the [[ROSA]] system (Zimmer Biomet, Warsaw, Indiana) in the Department of Neurosurgery and Craniomaxillofacial Surgery Amrita Institute of Medical Science, Amrita University, [[Kochi]], Kerala, [[India]].

Machine log file data were retrospectively analyzed to compare registration accuracy using 3 different methods: (1) facial laser scanning, (2) bone fiduciary, or (3) skin fiduciary.

Two hundred seven cranial neurosurgical procedures utilizing robotic assistance were performed in a 24-mo period. One hundred forty-five procedures utilizing the stereotactic mode included 33% stereotactic biopsy, 31% Stereo-EEG electrode insertion, 20% cranial navigation, 7% stereotactic catheter placement, 6% craniofacial stereotactic wire placement, 2% deep brain stimulation lead placement, and 1% stereotactic radiofrequency ablation. Sixty-two procedures utilizing the haptic endoscope guidance mode consisted of 48% transnasal endoscopic, 29% ventriculoscopic, and 23% endoport tubular access. Statistically significant differences in registration accuracies were observed with 0.521 ± 0.135 mm (n = 132) for facial laser scanning, 1.026 ± 0.398 mm for bone fiduciary (n = 22), and 1.750 ± 0.967 mm for skin fiduciary (n = 30; ANOVA, P < .001).

The combination of accurate, automated stereotaxy with image and haptic guidance can be applied to a wide range of cranial neurosurgical procedures. The facial laser scanning method offered the best registration accuracy for the ROSA system based on this retrospective analysis
((Pillai A, Ratnathankom A, Ramachandran SN, Udayakumaran S, Subhash P,
Krishnadas A. Expanding the Spectrum of Robotic Assistance in Cranial
Neurosurgery. Oper Neurosurg (Hagerstown). 2018 Sep 7. doi: 10.1093/ons/opy229.
[Epub ahead of print] PubMed PMID: 30203040.
)).
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In the case of surgery of the [[skull base]], it has just emerged from an experimental phase.

Neurosurgery is one of the first organ systems in which robotic surgery can play a role, due to the high precision that is required to localize and manipulate within the brain, and the relatively fixed landmarks of the cranial anatomy.

Robotic technology has been incorporated into stereotactic and endoscopic procedures
((Louw DF, Fielding T, McBeth PB, Gregoris D, Newhook P, Sutherland GR. Surgical robotics: A review and neurosurgical prototype development. Neurosurgery. 2004;54(3):525–537.))
((Mc Beth PB, Louw DF, Rizun PR, Sutherland GR. Robotics in neurosurgery. Am J Surg. 2004;188(4):68–75.)).

Interest in robotic endoscopic surgery is high because of the small size of the incisions, cosmetic advantages, less invasive surgical techniques, decreased scar tissue, shorter duration of hospitalization and increased cost-effectiveness
((Ichihara S, Bodin F, Pedersen JC, Porto de Melo P, Garcia JC Jr, Facca S,
Liverneaux PA. Robotically assisted harvest of the latissimus dorsi muscle: A
cadaver feasibility study and clinical test case. Hand Surg Rehabil. 2016
Apr;35(2):81-4. doi: 10.1016/j.hansur.2016.01.002. Epub 2016 Feb 18. PubMed PMID:
27117120.
)).

Other key neurosurgical applications for robots include robotised microscope 
((Giorgi C, Eisenberg H, Costi G, Gallo E, Garibotto G, Casolina DS. Robot-assisted microscope for neurosurgery. J Image Guid Surg. 1995;1(3):158–163.))
, telepresence 
((Hongo K, Goto T, Kakizawa Y, Koyama J, Kawai T, Kan K, et al. Micromanipulator system (NeuRobot): Clinical application in neurosurgery. Int Congr Ser. 2003;1256:509–513.))
, and tumor resection
((Benabid AL, Lavallee S, Hoffmann D, Cinquin P, Demongeot J, Danel F. Potential use of robots in endoscopic neurosurgery. Acta Neurochir Suppl (Wien) 1992;54:93–97.)).