Neurosurgical Robotics: A Cadaveric Feasibility Trial of Cerebrovascular Applications for the DaVinci Surgical System

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Introduction: The daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) has become standard instrumentation for prostatectomy and other urological procedures, and is FDA-approved for a wide spectrum of general and gynecological surgeries. Given its tremor reduction, motion scaling capabilities, multiple working arms, and patented Endowrist technology, which allows for full range of motion at the instrument head comparable with that of the human wrist, this device was tested at our institution for cerebrovascular applications as well. Methods: A cadaveric feasibility trial was undertaken to determine the utility of a commercially available telesurgery robot for cerebrovascular surgery. Several cadaveric brains were isolated, preserving the vertebrobasilar system. The normal basilar artery was manipulated, opened, and repaired with the existing instrumentation for the daVinci Surgical System. Video and photographic data were obtained in this qualitative analysis. Advantages and difficulties encountered are discussed. Results: Although the goal of cadaveric basilar repair with the surgical robot was achieved, there are obstacles to accessing and operating within these areas in vivo using this technology. A clear disadvantage to this telesurgery robot is the lack of feedback to the operator. Despite significantly improved vision with advances in optics and image guidance, other sensory feedback is lagging. Position, velocity, or acceleration of the instruments may be recognized through a combination of visual and proprioceptive cues. Without complete sensory feedback, however, other significant sensations are lost, including force on adjacent structures or characteristics of manipulated tissues such as compliance, texture, pulsatility, or elasticity. These are essential to the cerebrovascular microsurgical technique, and are areas of ongoing research in haptic interfaces. Also, the proximity of the working arms to each other and the optic apparatus, while ideal for intra-abdominal or pelvic surgery, is cumbersome when operating within a microsurgical field through a variety of skull base approaches. Conclusion: The daVinci surgical robot still requires both software modifications and hardware developments to maximize its utility in cerebrovascular surgery.

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