Article
Can a neurosurgeon ever be replaced by a robot? A glimpse into the future and review of current literature
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Authors
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Vidar Stenset
- Oslo University Hospital, Department of Neurosurgery, Oslo, Norway
| Published: | May 8, 2019 |
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Outline
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Objective: Optimising patient treatment and minimising procedure-related risk should be our main focus as new technologies enter operating theatres. The development of machine learning and artificial intelligence will improve decision-making and robotic assistants are expected to make surgery more precise and time efficient. Technical developments, such as intra-operative imaging and navigation, fluorescence-guided tumour resection, indocyanine green (ICG) angiography and neurophysiological monitoring have contributed to improved surgical precision and efficacy, making treatment safer and less invasive.
Methods: To assess the current state of and the use of robotics in the field of neurosurgery a review of current literature using the Pubmed database was performed. The keyword ‘neurosurgery’ was used in combination with ‘robotics’, ‘robot’, ‘augmented reality’ and ‘artificial intelligence’.
Results: Robotic assistants are making their entry, in particular, in stereotactic and spinal surgery where they have been shown to be precise and time effective.
Micro-neurosurgery, with minimal invasive procedures and narrow operating corridors in proximity to critical and sensitive structures, requires robots with adequate tactile feedback and response with regards to tissue resistance.
The use of master-slave systems may improve accuracy and safety in microsurgical procedures by reducing i.e. tremor and human error. However, the limited amount of studies available, have yet to show robotic systems to be superior to the skilled micro-neurosurgeon.
Conclusion: The use of robotics in neurosurgery is increasing and studies on clinical experience with robotic assistants show them to be accurate and time effective. Cost effectiveness and superiority to conventional surgery using navigation systems have not been established in most areas of neurosurgery. Will the neurosurgeon ever be able to sit back and supervise the autonomous performance of robots in the operating theatre? Will the use of robots make the less skilled neurosurgeon more skilled, or will it contribute to deterioration of surgical skills as we know it? Most importantly, will future use of robotic assistance improve patient outcome?
