Table Of Content

Robotics in Neurosurgery Principles and Practice Jorge Alvaro González Martínez Francesco Cardinale Editors 123 Robotics in Neurosurgery Jorge Alvaro González Martínez Francesco Cardinale Editors Robotics in Neurosurgery Principles and Practice Editors Jorge Alvaro González Martínez Francesco Cardinale Department of Neurological Surgery “Claudio Munari” Center and Epilepsy Center for Epilepsy Surgery University of Pittsburgh Medical Center Azienda Socio-Sanitaria Territoriale Grande Pittsburgh, PA, USA Ospedale Metropolitano Niguarda Milano, Italy Department of Medicine and Surgery Unit of Neuroscience Università degli Studi di Parma Parma, Italy ISBN 978-3-031-08379-2 ISBN 978-3-031-08380-8 (eBook) https://doi.org/10.1007/978-3-031-08380-8 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Our work is dedicated: to our patients to our wives, Andrea and Marina to our sons, Sophia, Alessandro and Chiara to our long-standing friendship Jorge and Cico Foreword “Hopefully we won’t have to use the Robot, today. It’s true, Pr Benabid wants us to use it. We need to understand how it works and give him and the engineers direc- tions for its fine-tuning, but what a pain! It means making the procedure much longer. For giving the coordinates, we only have X-rays in the two projections face and profile, and we practically have to input everything by hand. Then it doesn’t always go smoothly, because the ‘petits déplacements itératifs’ are at order of the day. Each trajectory must practically always be adjusted to the final position by means of small shifts. With just few approaches, ok it is still feasible. But when up to twenty trajectories are required as for Stereoelectroencephalography, there is the risk of never leaving the room. Of course, we can say that we used the robot, but what a struggle! Fortunately, the most difficult approaches, i.e. those in double obliquity, are also the most successful, practically always on the first shot. For the classic orthogonal trajectories of the Talairach frame, on the other hand, the simplicity and precision of the original approach remain unsurpassed, with the only limitation that the holes of the double grid allow only a limited and fixed num- ber of trajectories. We will arrive at the usual compromise in order not to waste too much time, most of the approaches, the orthogonal ones with the double grid and the oblique ones with the robot ….” It was 1990, and I had just arrived in Grenoble with my Master Claudio Munari and had the good fortune to work in the neurosurgery department of Prof. Alim Louis Benabid. With Dominique Hoffman we shared the commitments of the stereotactic room, and we were at the same time fascinated and terrified by the use of the first robot I had ever seen in a neurosurgical room. The robot is accurate, not that. The robot acts in the surgeon’s place, taking work away from him, and I can assure you that that took up all our energy. The robot does not get tired, that is true; of course it does not, but we were exhausted. But after only a short time, the results of constant work and fine-tuning were beginning to show the reliability and advantages of the surgical robot. How much time has passed since then and how the world of surgical robotics has been transformed by the people who invented the robots and made them! vii viii Foreword Now they do this and that, they align with sub-millimetric precision, they allow almost immediate and automatic registration of the patient’s head position, and they are driven by a very sophisticated planning software that allows planning using models that are increasingly close to the actual anatomy of the individual patient. The workflow has to be progressively implemented, but the advantages of using the robot are soon evident and there are also significant time savings. We, at the Claudio Munari Centre, also delayed until 2009 to switch completely to the use of the robot for SEEG, since then we can no longer do without it and the average time per implant has been reduced by several hours. Of course, in other surgeries, the robot is also the arm of the surgeon who can, for example, operate in master-slave mode and, in some cases, has greater auton- omy even though it is supervised by the surgeon. This is not yet the case in neurosurgery where the time does not seem to be ripe. But even in our specialty, the robot in its various presentations has become part of the routine and its evolution seems unstoppable. The possibility of controlling the surgical act and the reliability seem to be the main goals to be achieved, and imagin- ing a working robot is no longer confined to science fiction films. There is still a long way to go, but the continuous technological evolution allows us to glimpse at possible solutions and goals that are no longer unreachable. This book by my dear friends JGM and F(C)C represents the current state of the art and an undoubted reference for the developments we are aiming at. I wish them all the success I am sure they deserve. “Claudio Munari” Center for Epilepsy Surgery Giorgio Lo Russo Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda Milano, Italy Introduction The application of surgical robots in neurosurgery has been significant in the last decade, and it will likely continue to expand at an unparalleled rate. The develop- ment of computational engineering and adaptations to surgical methods related to the so-called minimally invasive surgical techniques have been the driving forces in recent years. The utilization of robotics in many surgical fields is becoming the new standard of care. Neurosurgery is not an exception. Robots have been applied to the manufacturing industry as earlier as the 1960s where they performed tasks like welding, assembly, shipping, handling of raw materials, and product packing. Only recently have they been applied to medicine. Interestingly, the inception of robotic technology in the field of medicine was in neurosurgery. Authors often differ in their definition of the first robotic procedure of the modern era, but arguably, Kwoh and colleagues were the first to use the PUMA 560 robotic system in stereotactic brain biopsies with great accuracy. Since then, the application of robots in neurosurgery has taken a slow but continuous progression, until the very last two decades, when it acquired a fast and diverse pace, involving several subfields in neurosurgery. Although the practical applications of robots are relatively recent, the concept is more than 100 years old. The word robot derives from the Czech word robota, which describes a forced labor or activity, in other words, a “slave machine.” The term rapidly became corrupted to reflect a machine-oriented repetitive task with no associated artificial intelligence. The Czech writer Karel Capek introduced the concept in his play “Rossum’s Universal Robots” in 1920, defining the term robot for the first time. In the play, the robots attempted to take control of their own destinies and taking independent decision. Although the science fiction nature of his play is evident, we can start realizing that it is closer in realization than we could possibly predict. The upcoming new technologies and the most recent human interactions with robots are triggering new adaptative behaviors in our societies, whether related to scientific, social, or legal spheres. To guide us into this journey and preserve the essence of our mission of improving the medical care and the quality of life of our ix x Introduction societies, we could perhaps recall some initial concepts in robotics, resting at the nebulous interface between fiction and reality. Many writers of robot stories, without actually quoting the three laws, take them for granted, and expect the readers to do the same. Isaac Asimov Isaac Asimov (1920–1992) was a prolific and provocative American writer. Many of his writings were related to science fiction, especially robots and their interaction with humans. In 1941, he wrote Runaround, the latest in a series of stories on robotic machines with positronic, humanlike brains in the era of space dis- coveries. In Runaround, three astronauts (two humans, Powell and Donovan, and a robot SPD-13—Speedy) are sent to an abandoned mining station on the apocalyptic planet of Mercury. While there, a compound necessary to power the station’s life- giving photocells, selenium, alters SPD-13 and causes him to become dysfunctional and confused, unable to operate under the three laws of robots. According to Asimov’s imagination, these laws are the following: (1) a robot must not injure a human being or allow a human to come to harm; (2) a robot must obey orders given by humans, except if the order conflicts with the first law; and (3) a robot must pro- tect its own existence as long as it does not conflict with the first and second laws. In the end, Powell was able to fix the photocells and Speedy went back to a normal function, and the mission was saved. Over the course of his prolific career, Asimov’s view on the sacredness of the three laws varied, from seeing them as simple rules and guidelines through to wholly uncompromising subroutines imprinted into the robot’s operational system. What is interesting is the fact that the “three laws” lifted robots from the mindless cadre of Frankenstein-like machines and creatures with no guiding principles that had characterized horror and science fiction for decades and gave them the capacity of dealing with moral dilemmas, as humans. In 1985, Asimov added a fourth law, known as the “zeroth law,” to precede the first law: a robot may not harm humanity or, by inaction, allow humanity to come to harm. Asimov’s laws were so highly regarded that it was as though his three laws would, in the real ages of robotics to come, be a foundational stone in a positronic Brave New World (in reference to the famous Aldous Huxley book). In the current age of automation, artificial intelligence, and social distancing, our interactions with machines and “intelligent” operating systems have acquired a new importance and the 100-year-old robot concept has suddenly acquired a new interest. The reality is that no computer or robot has so far had the three laws built into its network. They were, and remain, little more than imaginary literacy concepts, designed to further the plot of the finest science fiction models ever written, but maybe applicable in the near future. As opposed to science fiction, the collection of manuscripts present in this book attempts to describe the current state-of-the-art applications of robotic devices in Introduction xi neurosurgery. Our goal is to inform the readers regarding the new robotic technologies currently applied in neurosurgical interventions and research and perhaps guide them to new developments and applications for the next decade. Department of Neurological Surgery and Jorge González Martínez Epilepsy Center University of Pittsburgh Medical Center Pittsburgh, PA, USA e-mail: [email protected] “Claudio Munari” Center for Epilepsy Surgery Francesco Cardinale Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy Department of Medicine and Surgery, Unit of Neuroscience, Università degli Studi di Parma Parma, Italy e-mail: [email protected]