Richard Williamson, MD, FAANS
The use of robotics in surgical observe has been a area of fast growth throughout the previous few many years. The primary use of a robotic for neurosurgery was in 1985 when an industrial robotic was used to information biopsy cannulas underneath pc tomography steering, bettering accuracy and decreasing process time relative to a manually adjustable body. Though neurosurgery is amongst the final surgical fields to include this novel know-how, its potential utility can’t be understated.
Since robotics had been first launched, there was continuous enchancment in electronics miniaturization, medical imaging, picture evaluation, management idea, synthetic intelligence, and human-computer interfaces. There are a number of establishments have adopted these developments, together with Allegheny Well being Community (AHN). AHN grew to become the first hospital in the state of Pennsylvania to make use of the Synaptive Modus V, a digital surgical microscope with a robotic arm derived from earlier fashions used on the Worldwide House Station.
Lately, NeurologyLive® sat down with Richard Williamson, MD, FAANS, a neurosurgeon at AHN, to debate the advances in robotics, and particularly, the use of robotic exoscopes. An exoscope is a high-definition digital imaging system that permits surgeons to see a magnified, three-d picture of the surgical area throughout microsurgeries. Williamson, who believes robotics shall be integral to the progress of neurosurgery, offered perspective on the capabilities of these applied sciences and how they ease the operation.
Are you able to element the use of robotic exoscopes used in neurosurgery?
An exoscope is basically a high-fidelity digital camera with a light-weight supply that’s hooked up to a robotic arm. That arm could be positioned all through a surgical area in order to offer magnification illumination. Versus conventional microscope, which has basically an eyepiece that you simply put your eyes into it, you place your head on it, and you look in by means of the lens. That is oblique visualization, as a result of you’ve got a digital camera that is basically recording data, and then it tasks it to a display screen in the room, and then we’re that display screen. It is in actual time. Primarily, we’re working with our palms in a surgical area, however a display screen only a couple ft away.
How would you assess the performance of this exoscope? Can any neurosurgeon really feel snug selecting it up?
Just about any neurosurgeon can decide this up and begin to use it immediately. As half of our coaching, we’ve got different comparable devices, one of which we name an endoscope. That is principally a light-weight digital camera supply, however we sometimes put it inside the affected person both by means of a nasal cavity or another type of use. We have already got that workflow and some of these haptics in our thoughts the place we will basically do issues with our palms however the have a look at a display screen away from the surgical area.
That being mentioned, there are some nuances to how can we place the extra scope. In order that it does not get contaminated, in order that we will function round it. How can we optimize some of the visible settings on the exoscope to maximise the mild in the surgical space? There are totally different filters that we will apply, relying on the tissue that we’re working on. And so, utilizing some of that data, it takes time, and it takes expertise to realize that.
Is there any further recreation planning with these new applied sciences?
For each single surgical process, we provide you with a recreation plan. What are the targets of this process? What’s the vital anatomy that we’ll be working in or close to? What are the potential pitfalls? How are we going to arrange the know-how in the room? The place are we going to place the exoscope? How are we going to place the affected person? The place are we going to plan our incision? Do we’ve got all the issues that we want? There’s a lot that goes into simply the type of the setup and the planning for a surgical process. And with out that, it the surgical procedure will not be as profitable.
What are methods can we broaden the capabilities and makes use of of robotic exoscopes?
At present, it is getting used for all neurosurgical procedures the place we want each magnification illumination. Clearly, that is actually the breadth of all of neurosurgery. However the place we will broaden the use of this know-how is in different areas: integrating augmented actuality into the exoskope in order that we’re not solely seeing a projection of what the digital camera is seeing, however possibly it is displaying us what we will not essentially see with our bare eyes. Perhaps we will apply a filter and it may stain for a sure type of tumor, for eradicating a mind tumor, or it may spotlight the the blood vessels of the mind in order that we all know precisely the place vital buildings are, thus in the end making our surgical procedures extra exact and safer.
What sort of position will robotics play in neurosurgery in the coming years?
The purpose of all neurosurgery is to be exact. We need to be correct, and we need to be protected. These are the important tenants of all neurosurgeries. Robotics will help us with all these [aspects] by making all the things extra exact. We will combine some of the imaging that we do, the MRI scans and CT scans, into basically a robotic, which is monitoring that data. There’s even ways in which we will have robotics do parts of a process, some of the automated parts. We will use a CT scan of somebody’s mind and the define of their cranium, and with some precision, we will have a robotic take away or drill away a really small piece of the cranium to realize us surgical entry. That know-how, because it stands now, it’s not there but. However these are issues I feel are most likely coming inside the subsequent 5 or 10 years, and we can begin utilizing some of that know-how in the working room.
The one different factor that I’d point out is the stuff that we do not actually have a tendency to consider. As a result of the exoscope untethers you out of your laser mild supply and your magnification, there really is that this entire piece of what we name surgical ergonomics. That is the place I can place the lights to go in very excessive angles. Historically, I must transfer my head and my physique to attain that very same angle in surgical procedure. And now, I can carry out surgical procedures for longer with much less consolation. Not that it’s the most vital factor, however it is necessary, as a result of some of these procedures can take hours. If the surgeon can function extra comfortably for an prolonged interval of time, then in the end I feel the sufferers will profit.
Transcript edited for readability.