Title Primjena robotike u kranijalnim operacijama Title (english) Robotics application in cranial neurosurgery Author Joško Bilandžić Mentor Darko Chudy (mentor)Committee member Marko Radoš (predsjednik povjerenstva)Committee member Tomislav Meštrović (član povjerenstva)Committee member Darko Chudy (član povjerenstva)Granter University of Zagreb Defense date and country 2022-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Korištenje robotske tehnologije postalo je dio rutinske skrbi za različite indikacije u mnogim granama kirurgije. Robotika se primjenjuje u abdominalnoj kirurgiji, urologiji, ortopediji, torakalnoj te kardijalnoj kirurgiji. Koristi se također i u neurokirurgiji. Prvi tip robota za primjenu u kranijalnim operacijama razvijen je 1985. godine. Trenutno postoje različiti tipovi robota za primjenu u svim granama neurokirurgije.
Cilj ovoga rada je u narativno preglednoj formi izložiti trenutnu primjenu robotike u kranijalnim operacijama.
Ovisno o tipu kontrole nad radom robota, robotske sustave koji se primjenjuju u neurokirurgiji možemo podijeliti u tri velike skupine - autonomni sustavi, nadzirani sustavi i sustavi podijeljene kontrole.
Stereotaktički robotski sustavi najčešće su primjenjivani roboti u svakodnevnoj neurokirurškoj praksi. Glavna funkcija stereotaktičke robotske ruke jest pozicionirati držač instrumenta niz predoperativno isplaniranu trajektoriju. Robotska ruka na taj način stvara radni kanal koji operater koristi pri uzimanju bioptata ili postavljanju intracerebralnih elektroda. NeuroMate, PathFinder, ROSA i hrvatski robotski sustav RONNA primjeri su stereotaktičkih robotskih sustava.
Radiokirurški robotski sustavi sastoje se od linearnog akceleratora, robotske ruke, RTG uređaja i stola za namještaj pacijenta. Rendgensko snimanje pomaže pri lokalizaciji predoperativno isplaniranih ciljnih točaka što omogućava vrlo preciznu isporuku zračenja. CyberKnife jest primjer radiokirurškog robota.
Pri upotrebi telekontroliranih robotskih sustava operater upravlja robotskim rukama iz upravljačke konzole koja je udaljena od operacijskog polja. Korištenje robotskih ruku uklanja fiziološki tremor ljudske ruke. Također, telekontrolirani robotski sustavi omogućavaju bolju vizualizaciju endokranijalne mikroanatomije. NeuroArm je najčešće korišteni telekontrolirani robotski sustav u neurokirurgiji.
Endoskopski i endovaskularni roboti pripadaju u skupinu telekontroliranih robotskih sustava. Koriste se u neuroendoskopiji i intervencijskoj neuroradiologiji. Jedna od glavnih prednosti endovaskularnih robota, poput CorPath GRX robotskog sustava, jest smanjivanje doze zračenja kojoj su izloženi zdravstveni radnici za vrijeme postupka.
Korištenje robota u kranijalnim operacijama nudi prednosti poput standardizacije načina izvođenja operacije, uklanjanje tremora ljudske ruke te simulacije operativnih zahvata za vrijeme specijalističkog usavršavanja. S druge pak strane, dugačka krivulja učenja, pitanje financijske isplativosti i medikolegalna pitanja usporavaju daljnje širenje primjene robotske tehnologije u rutinskom neurokirurškom radu.
Abstract (english) The usage of robotic technology has become standard of care for various indications in many surgical specialties. It is used in abdominal surgery, urology, orthopedics, thoracic surgery and cardiac surgery. Neurosurgery is no exception. The first type of robot for application in cranial surgery was developed in 1985. Currently, different types of robots are available for all neurosurgical subspecialities.
The goal of my thesis is to outline currently used robots in the cranial surgery. Paper is written in the form of a narrative review.
Based on the type of control over robot all robotic systems used in neurosurgery are categorized into one out of three groups - autonomous systems, dependent systems (master-slave) and shared-control systems.
Stereotactic robots are type of robotic systems most commonly used in neurosurgery. The main function of a robotic hand is to delineate preoperatively planned trajectory. The robotic hand then serves as a work channel for surgeon to take biopsy or to place an electrode. NeuroMate, PathFinder, ROSA and Croatian robotic system RONNA are examples of stereotactic robotic systems.
Radiosurgical robotic systems consist of a linear accelerator, a robotic hand, X – ray imaging source and a robotic table for patient positioning. X - rays help in the localization of preoperatively planned targets in order to enable linear accelerator highly accurate radiation delivery. CyberKnife is example of a radiosurgical robot. In teleoperated robotic systems a surgeon navigates robotic hands with a central control panel which is separated from the operating field. The usage of robotic hands reduces physiological hand tremor. Additionally, teleoperated systems help in better visualization of endocranial microanatomy. NeuroArm is most widely used teleoperated robotic system in neurosurgery.
Endoscopic and endovascular robots belong to the group of teleoperated robotic systems. They are utilized in neuroendoscopy and interventional neuroradiology, respectively. One of the main advantages of endovascular robots, such as CorPath GRX Robotic System, is reducing physicians' exposure to radiation during the procedure.
The application of robots in cranial surgery offers benefits such as standardization of procedure, elimination of hand tremor or surgery simulation during residents' training. However, a long learning curve, financial and legal issues remain to be addressed before further involvement of robots in neurosurgical routine.
Keywords
robotska kirurgija
stereotaksija
radiokirurgija
kranijalne operacije
telekontrolirani robotski sustavi
Keywords (english)
robotic surgery
stereotaxy
radiosurgery
cranial surgery
teleoperated robotic systems
Language croatian URN:NBN urn:nbn:hr:105:582879 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-01-03 11:46:50
