“This MR-compatible robot is relatively dextrous, and capable of performing both microsurgery and stereotaxy,” states Dr. Garnette Sutherland, project leader for NeuroArm. “The robot is the only one in the world with such capabilities.”
NeuroArm could expedite patient care; for example, during diagnostic MR imaging for suspected cancer, the robotic arm could be deployed into the MR machine to biopsy the suspected lesion. The immediate biopsy eliminates the need for multiple referrals, reducing the time to diagnosis. The accuracy of the biopsy would be enhanced by near real-time MR imaging. This way, the surgeon is able to guide the robot to the target using an image-based surgical strategy.
As an MR-compatible ambidextrous robot, NeuroArm is capable of performing the most technically challenging surgical procedures. The robot has two manipulators that mimic human hands, which can be interchanged with novel microsurgical tools. Filters eliminate unwanted tremors, which may be magnified by the stress of surgery. A surgeon guides the robot using hand controllers at a workstation. The workstation recreates the sight, sound and sensation of surgery. Sight is provided by a 3D visual display of the surgical site and 3D MRI displays. Surgical navigation and simulation software allows the surgeon to determine the optimal incision site, plan a path that avoids critical structures, and permits risk-free rehearsal of rare or complex procedures.
A special feature of NeuroArm is its sense of touch, referred to as haptics. “To optimize surgical dissection, surgeons integrate sight, sound, and touch from prior experience,” says Sutherland. “When I operate on the brain, I know how soft it is and so I manipulate the tissue based on that knowledge. With NeuroArm, we will be able to quantify this knowledge, [and this will have] a considerable impact on education.” For the first time, surgical trainees will know the amount of force that will cause damage to tissue. NeuroArm will have built-in controls inhibiting excessive force, increasing the safety of surgery.
Regions defined as ‘no-go zones’ can be predetermined and interfaced with the sense of touch, preventing the surgeon from moving the robotic arm beyond the planned surgical corridor. “This safety feature has the potential to reduce the complications associated with microsurgery,” says Sutherland.
The creation of such a robot, set for installation in late 2006, represents a powerful collaboration between university, industry, and community. While medical robotics are gaining international interest, “we have a unique advantage,” says Sutherland. “We are collaborating with an established and successful robotics company, and we have tremendous support from the Calgary community. Together, we are transferring technologies developed for space into the operating room.”
By integrating robotic precision with modern imaging technologies, surgeons will be able to take full advantage of the digital operating room environment. NeuroArm will dramatically enhance the safety of existing procedures, as well as permit new operations that are not currently possible. It will push minimally invasive surgery to new limits, while minimizing morbidity (illness or complications) and shortening hospital stays.
With a spatial accuracy of 30 microns (one micron is equal to one millionth of a metre, or 0.001 millimetres), NeuroArm provides unprecedented tool manipulation. As the robotic manipulators will be image guided, surgical complications—such as haemorrhage or brain injury—will be minimized.
Integrating NeuroArm into a magnetic resonance (MR) environment will enhance the development of image-guided surgery. Presently, to obtain an MR image during surgery, surgeons must stop operating and move either the patient to the magnet or the magnet to the patient. “As NeuroArm will be able to operate within the magnet, this disruption will be eliminated,” explains Sutherland. “For the first time, surgeons will be able to operate within the image.” That means surgeons can see exactly what they are operating on through continuous imaging.
Project NeuroArm also reaches well beyond the creation of a robot. Robotic systems provide the capability for playback, allowing surgeons and trainees to evaluate past procedures and enhance their surgical performance. To further improve surgery, project NeuroArm includes the development of a patient-specific virtual brain. Within the virtual environment, surgeons can rehearse procedures prior to the operation. “Project NeuroArm will not only change how surgery is performed, but also how it is rehearsed and taught,” states Sutherland.
The project also includes the design and construction of unique surgical tools. “In the past, tools have been designed for surgery based on human hand-eye coordination,” he says. “If we are no longer restrained by the human hand, [this gives us a] great degree of freedom in the design of tools that can accomplish multiple tasks.”
Project NeuroArm provides an infrastructure whereby investigators from various university faculties and institutions can cooperate; this cross-collaboration is ideally posed to improve surgical outcome. In addition, the project provides a fertile environment for the recruitment and advancement of talented individuals who will ultimately impact both the Canadian high-tech and healthcare sectors.
The Seaman Family MR Research Centre began as a partnership between investigators at the University of Calgary (U of C), the Calgary Health Region, and the business community of Calgary. Other partners for NeuroArm include MDA, Western Economic Diversification Canada, National Research Council, C-STAR, Innovative Magnetic Resonance Imaging Systems, Centre for Minimal Access Surgery, and Harvard University’s Brigham and Women’s Hospital.
The MR Centre provides a working environment for both scientists and clinicians. This is important for project NeuroArm as it is dependent upon multidisciplinary collaboration. Medical researchers for the project are working across various U of C faculties such as engineering, kinesiology, education, and computer science.