MRI-Guided Robot-Assisted Interventions: An Opportunity and a Challenge in Computational Surgery

Author(s):  
Nikolaos V. Tsekos ◽  
Erol Yeniaras ◽  
Ahmet Eren Sonmez
Robotica ◽  
2009 ◽  
Vol 28 (2) ◽  
pp. 215-234 ◽  
Author(s):  
Andrew A. Goldenberg ◽  
John Trachtenberg ◽  
Yang Yi ◽  
Robert Weersink ◽  
Marshall S. Sussman ◽  
...  

SUMMARYThis paper reports on recent progress made toward the development of a new magnetic resonance imaging (MRI)-compatible robot-assisted surgical system for closed-bore image-guided prostatic interventions: thermal ablation, radioactive seed implants (brachytherapy), and biopsy. Each type of intervention will be performed with a different image-guided, robot-based surgical tool mounted on the same MRI-guided robot through a modular trocar. The first stage of this development addresses only laser-based focal ablation. The robot mechanical structure, modular surgical trocar, control architecture, and current stage of performance evaluation in the MRI environment are presented. The robot actuators are ultrasonic motors. A methodology of using such motors in the MRI environment is presented. The robot prototype with surgical ablation tool is undergoing tests on phantoms in the MRI bore. The tests cover MRI compatibility, image visualization, robot accuracy, and thermal mapping. To date, (i) the images are artifact- and noise-free for certain scanning pulse sequences; (ii) the robot tip positioning error is less than 1.2 mm even at positions closer than 0.3 m from the MRI isocenter; (iii) penetration toward the target is image-monitored in near-real time; and (iv) thermal ablation and temperature mapping are achieved using a laser delivered on an optical fiber and MRI, respectively.


Urology ◽  
2009 ◽  
Vol 74 (4) ◽  
pp. S13
Author(s):  
U. Lindner ◽  
A. Goldenberg ◽  
M. Haider ◽  
W. Kucharczyk ◽  
M. Sussman ◽  
...  
Keyword(s):  

2018 ◽  
Vol 63 (20) ◽  
pp. 20NT02 ◽  
Author(s):  
Pedro Moreira ◽  
Niravkumar Patel ◽  
Marek Wartenberg ◽  
Gang Li ◽  
Kemal Tuncali ◽  
...  

2020 ◽  
Vol 36 (6) ◽  
pp. 1131-1142 ◽  
Author(s):  
Santiago Candela-Cantó ◽  
Mariana Alamar ◽  
Carlos Aláez ◽  
Jordi Muchart ◽  
Carolina Forero ◽  
...  

2016 ◽  
Vol 41 (4) ◽  
pp. E5 ◽  
Author(s):  
Alvin Y. Chan ◽  
Diem Kieu T. Tran ◽  
Amandip S. Gill ◽  
Frank P. K. Hsu ◽  
Sumeet Vadera

Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to treat a variety of intracranial lesions. Utilization of robotic assistance with stereotactic procedures has gained attention due to potential for advantages over conventional techniques. The authors report the first case in which robot-assisted MRI-guided LITT was used to treat radiation necrosis in the posterior fossa, specifically within the cerebellar peduncle. The use of a stereotactic robot allowed the surgeon to perform LITT using a trajectory that would be extremely difficult with conventional arc-based techniques. A 60-year-old man presented with facial weakness and brainstem symptoms consistent with radiation necrosis. He had a history of anaplastic astrocytoma that was treated with CyberKnife radiosurgery 1 year prior to presentation, and he did well for 11 months until his symptoms recurred. The location and form of the lesion precluded excision but made the patient a suitable candidate for LITT. The location and configuration of the lesion required a trajectory for LITT that was too low for arc-based stereotactic navigation, and thus the ROSA robot (Medtech) was used. Using preoperative MRI acquisitions, the lesion in the posterior fossa was targeted. Bone fiducials were used to improve accuracy in registration, and the authors obtained an intraoperative CT image that was then fused with the MR image by the ROSA robot. They placed the laser applicator and then ablated the lesion under real-time MR thermometry. There were no complications, and the patient tolerated the procedure well. Postoperative 2-month MRI showed complete resolution of the lesion, and the patient had some improvement in symptoms.


2020 ◽  
Vol 11 ◽  
Author(s):  
Kunal Gupta ◽  
Adam S. Dickey ◽  
Ranliang Hu ◽  
Edward Faught ◽  
Jon T. Willie

Robotic systems have fundamentally altered the landscape of functional neurosurgery. These allow automated stereotaxy with high accuracy and reliability, and are rapidly becoming a mainstay in stereotactic surgeries such as deep brain stimulation (DBS), stereoelectroencephalography (SEEG), and stereotactic laser ablation/MRI guided laser interstitial thermal therapy (MRgLITT). Robotic systems have been effectively applied to create a minimally invasive approach for diagnostics and therapeutics in the treatment of epilepsy, utilizing robots for expeditious and accurate stereotaxy for SEEG and MRgLITT. MRgLITT has been shown to approach open surgical techniques in efficacy of seizure control while minimizing collateral injury. We describe the use of robot assisted MRgLITT for a minimally invasive laser anterior temporal lobotomy, describing the approach and potential pitfalls. Goals of MRgLITT are complete ablation of the epileptogenic zone and avoiding injury to uninvolved structures. In the middle fossa these include structures such as cranial nerves in the skull base and cavernous sinus and the thalamus. These can be mitigated with careful trajectory planning and control of laser ablation intensity.


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