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Robot-Assisted Microsurgery Enhances Neurosurgical Procedures
SAN FRANCISCO (April 10, 2000)- Neurosurgeons recently discovered that Robotic-Assisted Microsurgery (RAMS) has the capability of both improving the manual dexterity of neurosurgeons and microsurgical outcomes for patients. This new technology, which was tested using a prototype system developed jointly by National Aeronautic and Space Administration (NASA), the Jet Propulsion Laboratory and MicroDexterity Systems, will be described at the 68th Annual Meeting of the American Association of Neurological Surgeons (AANS) in San Francisco, California, April 8-13.
Microsurgery is a fundamental technique used in neurosurgery that requires many years of training to be proficient. It can be viewed as a technique that allows the instruments to become specialized extensions of the surgeon's hands. In performing microsurgery, the surgeon must learn to manipulate body tissue with the instruments and not his or her hands. However, the full potential of microsurgery is limited by the level of the individual surgeon's manual dexterity. In addition, several factors such as lengthy surgeries or surgery done under a time constraint-such as experienced during neurovascular procedures-can adversely affect the surgeon's technical performance.
Using RAMS, the surgeon holds a master input handle, similar to a surgical instrument to command the motions of the robot instrument. The surgeons hand motions are then transferred in real-time through a computer system, where they are processed to automate the robot. Sensor signals from the instrument are monitored and modified by the computer. This process reduces the surgeons movement at the tissue level and prevents an incorrect movement or tremor associated with anxiety, fatigue, or age.
"Outcome in microsurgical procedures is often dependent on technical quality. This enhanced precision provided by robot systems may have profound effects on outcome for all surgeons," said Peter LeRoux, MD, a New York neurosurgeon and member of the AANS.
The development of telerobotic systems to assist surgeons is a growing field of research. Robots are already being used in neurosurgical procedures for image acquisition and integration, postitioning stereotactic frames or as a microscope holder. Dr. Le Roux and his colleagues took another step with surgical robots: using the robot to perform the surgery.
The goal of their study was to use the RAMS system to perform microrepair and suture of the rat carotid arteriotomy. The authors were not able to use the RAMS system to place sutures, instead the robot was used to manipulate or hold the materials being sutured. However, they found that the RAMS system could be used to successfully complete complex microsurgical skills including knot tying. The surgical results and error rate using telerobotic surgery were similar to that of conventional microsurgical methods. Although further research is needed, the prototype RAMS system suggests that robot-assisted microsurgery is already feasible for use in neurosurgery.
According to Dr. Le Roux, neurosurgeons' physical and psychological abilities are diverse and may vary during an individual surgeon's lifetime or even during a procedure. "The role of the robot-assisted system is to enhance and standardize a procedure", said Dr. LeRoux. "Surgical robots have the ability to reduce variation in outcomes for both a multi-specialty surgical team and for an individual surgeon."
Robots also are able to provide greater three-dimensional spatial accuracy, achieve greater and more accurate precision, provide access to difficult areas-all devoid of human fatigue. All these factors can help improve patient outcomes. Telepresence surgery is the most exciting possibility of surgical robots; when coupled with telecommunications, a surgeon using a robot system can help a colleague in another institution or even another country. This will mean that the unique abilities or expertise of a surgeon can be available to all patients, everywhere.
The RAMS system can potentially be used in any microsurgical procedure - for example repair of cerebral aneurysm, anatomsis of blood vessels or nerves, resection of brain tumor or vascular malformation, removal of acoustic neuroma etc. The system can also be coupled with endoscopes to allow minimally invasive surgeries.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons is a scientific and educational association with nearly 5,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are Board-certified by the American Board of Neurological Surgery. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous system and peripheral nerves.
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Media Representatives: The Annual Meeting press kit can be found in the Media Center Section of the AANS Web site at: http://www.neurosurgery.org/aans.
If you would like to cover the meeting or interview a neurosurgeon - either on-site or via telephone - please contact the AANS Communications staff at (847) 692-9500 or call the Annual Meeting Press Room beginning Sunday, April 9, at (415) 978-3715 (3716).
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