Introduction

When mentioned in conversations, robotic surgery calls to mind visions of huge machines taking the place of doctors in empty operating rooms. Robotic surgery and its various strategies and uses, however, promise to provide a much more practical and helpful role in transforming healthcare than just reducing surgeons’ workloads.

In brain surgery specifically, targeting and accessing certain areas to remove target tumors remain difficult for even highly trained surgeons who are limited by the human hand. It wasn’t until 1985 that the long-held dream of robotic surgery, despite being in its early stages, became a reality. Since then, numerous robotic surgery devices, including da Vinci Surgical System and ROSA, have become commonly used in assisting surgeons. Initially used to perform brain biopsies, robotic surgery currently presents a highly accurate and personalized possibility in delicate brain surgeries. 

How Are Robotic Surgeries Performed and What Makes Them So Widely Used?

Generally, a surgical robot consists of three parts: robotic arms with instruments, a high definition camera for magnification of surgical areas, and a console controlled by a surgeon overseeing the operation. In traditional surgery, one large incision is made near the operating area to create a workspace for the surgeon, while in robotic surgery, several small incisions are made. Next, thin tubes called ports are placed through incisions, acting as small tunnels for medical instruments to pass through.

Besides surgical instruments, an endoscope (a long, thin camera) is also placed through the ports for an accurate view of images during the procedure. Once the surgery is complete, the instruments and ports are removed, and incisions are closed with sutures. The robotic method limits the need to move tissue, muscles, and organs through and also reduces chances of scarring from the operation. Observed benefits post-surgery include less pain, reduced blood loss, and faster recovery times (patients able to return home in just a day). 

How Robotic Surgeries Can Benefit Brain Surgery: Now and in the Future?

A study from the University of Toronto presents a new technology in treating cancer in the brain. Their study focused on treating glioblastoma, a fast-growing and common type of cancer that is formed from astrocytes in the brain and spinal cord. Previous approaches like conventional surgery and chemo/targeted therapy weren’t fully successful due to cancerous cells spreading to other brain tissues and developing resistance to treatment. The research team’s proposed solution is to use magnetically guided robotic nano-scalpels that can precisely target cancer cells and kill them.

‘Nano-scalpels’ are actually magnetic carbon nanotubes (mCNTs), cylindrical structures made of carbon atoms and filled with iron oxide particles. After activation, mCNT stimulation disrupts harmful GBM cell structures, leading to programmed cell death. This method has proven itself to be effective in experimental trials, with experiments on mice with chemo-resistant GBM demonstrating a reduced tumor size and extended survival times. 

Another area of interest where robotic surgery could benefit brain surgery is in imaging and visualization. Before surgeries occur, imaging of the brain is done to get an overview of locations of tumors, tissues, and other components. However, when drilling or cutting to open up the brain for surgery, anatomy can be shifted. This makes the pre-surgery imaging inaccurate to the actual position of parts post-drilling.

An alternative, live-imaging during the surgery, has its cons due to patient exposure to radiation over the long scanning period. A combined team from John Hopkins, Medtronic (a medical device company), and the National Institutes of Health are working on developing a navigation system called “augmented endoscopy.”

After receiving video footage from endoscopes and taking into account camera position, the SLAM algorithm transforms observations into a 3D model of the inside of the patient’s skull. The model is then overlaid with a live feed to observe necessary structures in real time.

“Think of it as a dynamic 3D map of a patient’s brain that you can use to track and match deep brain deformation with preoperative imaging,” Prasad Bagdargi, primary author of the study, says. Preclinical trials found this method to be 16 times faster than older vision techniques while maintaining the same accuracy. 

How have robotic surgeries transformed patients?

Patient testimonials from various forms of cancer surgery underscore how transformative robotic surgery can truly be. For instance, John Hammond, who underwent a robotic bladder removal surgery, was up and walking the day after the procedure and returned home just five days later. Similarly, Janice Gerl, who was the first patient in Wisconsin to undergo surgery with the da Vinci 5 robotic system, experienced a smooth recovery from colon cancer surgery, which allowed her to return to her family and passions sooner than expected.

While these outcomes highlight the positive benefits of robotic surgery, safety concerns have also emerged. A study has linked robotic surgery to at least 144 deaths and over 1,000 injuries over a 14-year period in the United States, raising questions about the technology’s overall safety despite its promising potential.

Conclusion

Robotic surgery is revolutionizing brain surgery by enhancing precision, reducing scarring, and speeding recovery. With innovations like nano-scalpels and augmented endoscopy, robots are improving treatments for neurological diseases. As technology advances, robots might soon perform surgeries with more finesse than any human—maybe even brewing a perfect cup of coffee while they’re at it!