Frameless Robot-Assisted vs Frame-Based Awake Deep Brain Stimulation Surgery: An Evaluation of Technique and New Challenges

Fenoy, Albert J.; Conner, Christopher R.

doi:10.1227/ons.0000000000000059

Cited by 5 publications

(7 citation statements)

References 32 publications

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“…Our overall mean OR and procedural times, 272 and 145 minutes, respectively, were comparable with recently published studies using other robotic systems with mean OR times of 281 to 314 minutes and mean procedure times of 165 to 198 minutes. 18,38 In our experience, the robot-assisted procedure was significantly faster than the frame-based procedure. We also did observe an improvement in overall OR and procedure time from the beginning of our transition to robotic DBS to the end of this study because the last 10 cases were performed faster than the first 10 ( P = .03).…”

Section: Discussionmentioning

confidence: 82%

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Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow

Giridharan

Katlowitz

Anand

et al. 2022

Operative Neurosurgery

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BACKGROUND: A number of stereotactic platforms are available for performing deep brain stimulation (DBS) lead implantation. Robot-assisted stereotaxy has emerged more recently demonstrating comparable accuracy and shorter operating room times compared with conventional frame-based systems. OBJECTIVE: To compare the accuracy of our streamlined robotic DBS workflow with data in the literature from frame-based and frameless systems. METHODS: We retrospectively reviewed 126 consecutive DBS lead placement procedures using a robotic stereotactic platform. Indications included Parkinson disease (n = 94), essential tremor (n = 21), obsessive compulsive disorder (n = 7), and dystonia (n = 4). Procedures were performed using a stereotactic frame for fixation and the frame pins as skull fiducials for robot registration. We used intraoperative fluoroscopic computed tomography for registration and postplacement verification. RESULTS: The mean radial error for the target point was 1.06 mm (SD: 0.55 mm, range 0.04-2.80 mm) on intraoperative fluoroscopic computed tomography. The mean operative time for an asleep, bilateral implant without implantable pulse generator placement was 238 minutes (SD: 52 minutes), and skin-to-skin procedure time was 116 minutes (SD: 42 minutes). CONCLUSION: We describe a streamlined workflow for DBS lead placement using robotassisted stereotaxy with a comparable accuracy profile. Obviating the need for checking and switching coordinates, as is standard for frame-based DBS, also reduces the chance for human error and facilitates training.

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Section: Discussionmentioning

confidence: 82%

“…36,37 Using the O-arm intraoperatively for robot registration eliminates time for transporting the patient to a CT scanner which has been noted to add significant time in previously described workflows. 38 Draping in the O-arm allows for rapid acquisition of a spin after placing the leads.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow

Giridharan

Katlowitz

Anand

et al. 2022

Operative Neurosurgery

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“…5,17-23 Four studies reported their use of a skull-mounted robot with optical array registration/navigation, with a target radial error of 1.12 ± 0.54 mm (n = 406 electrodes), operative time of 155.4 ± 36.5 minutes (n = 406), and total procedure time of 277.1 ± 38.2 minutes (n = 165). 7,24-26 Three studies (including this study) reported the use of a floor-mounted robot with a frameless transient fiducial array, with a target radial error of 0.84 ± 0.54 mm (n = 631 electrodes), operative time of 182.4 ± 47.8 minutes (n = 315), and total procedure time of 311.9 ± 63.0 min (n = 315). 27,28 One study reported their use of a floor-mounted robot with optical registration, and the only metric recorded was target radial error: 1.28 ± 0.37 (n = 60 electrodes).…”

Section: Resultsmentioning

confidence: 99%

Robot-Assisted Minimally Invasive Asleep Single-Stage Deep Brain Stimulation Surgery: Operative Technique and Systematic Review

Fayed,

Smit,

Vinjamuri

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Robotic assistance has garnered increased use in neurosurgery. Recently, this has expanded to include deep brain stimulation (DBS). Several studies have reported increased accuracy and improved efficiency with robotic assistance, but these are limited to individual robotic platforms with smaller sample sizes or are broader studies on robotics not specific to DBS. Our objectives are to report our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery and to perform a meta-analysis comparing techniques from previous studies. METHODS: We performed a single-center retrospective review of DBS procedures using a floor-mounted robot with a frameless transient fiducial array registration. We compiled accuracy data (radial entry error, radial target error, and 3-dimensional target error) and efficiency data (operative time, setup time, and total procedure time). We then performed a meta-analysis of previous studies and compared these metrics. RESULTS: We analyzed 315 electrodes implanted in 160 patients. The mean radial target error was 0.9 ± 0.5 mm, mean target 3-dimensional error was 1.3 ± 0.7 mm, and mean radial entry error was 1.1 ± 0.8 mm. The mean procedure time (including pulse generator placement) was 182.4 ± 47.8 minutes, and the mean setup time was 132.9 ± 32.0 minutes. The overall complication rate was 8.8% (2.5% hemorrhagic/ischemic, 2.5% infectious, and 0.6% revision). Our meta-analysis showed increased accuracy with floor-mounted over skull-mounted robotic platforms and with fiducial-based registrations over optical registrations. CONCLUSION: Our technique for robot-assisted, minimally invasive, asleep, single-stage DBS surgery is safe, accurate, and efficient. Our data, combined with a meta-analysis of previous studies, demonstrate that robotic assistance can provide similar or increased accuracy and improved efficiency compared with traditional frame-based techniques. Our analysis also suggests that floor-mounted robots and fiducial-based registration methods may be more accurate.

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“…In recent reports of errors achieved with other robot-assisted DBS, mean radial errors ranged from 0.6 to 1.7 mm and most studies comparing errors with the classic method showed better non-inferior outcomes in robot groups; the errors from other robot-based DBS surgeries are shown in Table 2 [12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Accuracy and safety of deep brain stimulation assisted by a neurosurgical robot attachable to the operating table

Cheon,

Jo,

Youn

et al. 2023

J Korean Ster Func Neurosurg

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Objective: Neurosurgical robots have recently been introduced to assist in guiding trajectories to achieve accurate targeting. This study investigated the accuracy of robot-assisted deep brain stimulation (DBS) compared with conventional DBS using the Leksell arc system.Methods: Between October 2020 and September 2021, 29 patients underwent DBS using the Leksell arc system, while from October 2021 to August 2022, 20 patients underwent DBS using a neurosurgical robot system (KYMERO; Koh Young Technology). Radial errors, total operative time (surgery time, preparation time), and clinical outcomes were compared between both groups through a retrospective analysis. Results: Radial errors were significantly smaller in robot-assisted DBS (1.63±0.39 mm vs. 1.01±0.39 mm, p<0.01). Furthermore, the error of the second implantation was smaller than in the Leksell DBS group (0.216 vs. 0.005 mm, p<0.001). The total operative time of DBS with Leksell frame was 3.47 hours (range, 2.38-5.85 hours) and the surgery time was 2.21 hours (range, 1.08-4.67 hours), while the total operative time in the robot group was 3.92 hours (range, 2.75-5.85 hours) and the surgical time was 2.60 hours (range, 1.02-4.67 hours) (p=0.055, p=0.258, respectively). The clinical outcome did not show a significant difference according to the surgical method.Conclusion: DBS with a robot-assisted system enables the accurate and consistent insertion of DBS electrodes with a lower error rate than the conventional method.

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Frameless Robot-Assisted vs Frame-Based Awake Deep Brain Stimulation Surgery: An Evaluation of Technique and New Challenges

Cited by 5 publications

References 32 publications

Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow

Robot-Assisted Deep Brain Stimulation: High Accuracy and Streamlined Workflow

Robot-Assisted Minimally Invasive Asleep Single-Stage Deep Brain Stimulation Surgery: Operative Technique and Systematic Review

Accuracy and safety of deep brain stimulation assisted by a neurosurgical robot attachable to the operating table

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