The future of neurosurgery. Here’s how we’re getting there.
Where we’re from
Project neuroArm began from an idea. How can we make surgery safer? What will it take to create an optimal outcome for every neurosurgical patient? To begin, we have to bring high resolution imaging into the operating room.
In 1997, the intraoperative magnetic resonance imaging (iMRI) project was established. The goal of the program was to bring a high field MRI system into the operating room (OR) for the first time. Believing that keeping the patient stationary while moving the MRI would be safer than moving the patient to the machine, Dr. Garnette Sutherland and a team from the National Research Council Institute for Biodiagnostics in Winnipeg ventured to create the world’s first movable high field magnet. The first system, based on a 1.5T magnet, was constructed at the National Research Council facility in Winnipeg and successfully showed proof of concept for the moving high field magnet.
At the same time, construction was underway to build the Seaman Family MR Research Centre. Significant funding was received from the Seaman family, Alberta Infrastructure and the Partners in Health Fundraising Campaign. The Centre was designed and built to house both the iMRI program and the High Field MRI research program and received establishment funding from the Canada Foundation for Innovation. Today, the Centre continues to produce world class research in the field of imaging as it applies to neurosurgery, stroke, multiple sclerosis and mental disease, to name a few.
Following proof of concept in Winnipeg, the iMRI program was initiated in Calgary. The prototype system was built, tested and used for the first time in neurosurgery on December 4, 1997. A spinoff company designed to distribute the technology, IMRIS Inc., was established in 1997 and the unique technology was patented. IMRIS (TSX:IM) continues to manufacture and distribute the systems to medical centres around the world today. They currently have over 35 international sites, employing more than 130 people and are listed publicly on both the TSX and NASDAQ.
In June 2008 the 1.5T iMRI system was decommissioned after participating in over 1000 neurosurgeries. Thanks to additional funding from Alberta Advanced Education and Technology, Western Economic Diversification and from the Calgary Health Trust, the system has been upgraded to a 3.0T magnetic platform- another world-first. It continues to provide unique opportunities for research, training and patient care at the Foothills Medical Centre.
The introduction of MRI to the OR presented a disruption to the rhythm of surgery. Surgery had to be paused while real-time images of the patient’s brain were being acquired. It was at this time when Dr. Garnette Sutherland asked the question, “Wouldn’t it be great if we could continue to operate while images are being taken, in the bore of the magnet?”
From idea to reality
This concept presented a number of unique challenges. How could a machine be created to be as precise and dexterous as the human hand, without compromising surgical technique? How could a machine with cameras, motors and actuators be made from non-ferromagnetic materials so as not to be affected by the magnet or adversely affect the images? Would the machine be capable of being integrated into surgical procedure with minimal disruption to the traditional workflow?
From 2002 to 2007, Dr. Garnette Sutherland and his team at the University of Calgary, together with engineers at Macdonald Dettwiler and Associates (MDA) worked to overcome these challenges. The project, through preliminary design review, critical design review and various requirements documents, found creative solutions to each of the challenges presented, using haptic control mechanisms, piezoelectric motors, semi-automated tool exchange protocols and communications technologies. In 2006, a patent for the invention was filed and in 2007 the filing was approved. Subsequent to that filing, six additional patents are pending.
On April 13, 2007, the robot was officially unveiled to the world. The launch was covered by several national and international media outlets, resulting in over 300,000 articles appearing in print, video and web-based medias worldwide.
Over the following year, Project neuroArm undertook the extensive work required to make the robotic system available for use on human patients. Testing of the system’s interaction with the iMRI system, developing appropriate sterile drapes, experimental use of the robot on models and animals, as well as regulatory approvals from the University of Calgary ethics board and Health Canada’s Therapeutic Products Directorate were undertaken.
On May 12, 2008, the public was invited into the iMRI operating room to see for the first time an image-guided MR-compatible robotic neurosurgical procedure. The patient, 21-year-old Paige Nickason, was having an egg-shaped olfactory groove meningioma removed. The procedure had no complications and, later that week, Paige participated in a press conference surrounding the event. An image gallery and short video of the surgery are posted here.
Since 2008, neuroArm has been undergoing some modifications. As previously mentioned, the iMRI system was decommissioned in June 2008, in order to upgrade to the 3.0T platform. As the MR system was changed from locally-shielded to a room-shielded system, this necessitated a complete renovation of the iMRI operating theatre. This change also made necessary some major modifications to the robot, which were completed in July 2010.
Where we’re going
Included in the grants provided by our funding agencies is the provision for a second generation robotic system, neuroArm2. Development of neuroArm2 is well underway, with a requirements document nearly completed and preliminary design taking shape.
The research team has also recently moved into the new robotics research facility at the Health Research Innovation Centre at the University of Calgary Foothills Campus. The research space includes four key areas: a haptic research and surgical performance laboratory, an advanced engineering and prototyping laboratory, an experimental operating theatre and a telementoring and debriefing room.
The goal of the Surgical Performance Lab is to change how surgeons interact with the operative environment. Within a patient-specific sensory-immersive environment, surgeons and trainees will be able to rehearse procedures and evaluate performance under diverse conditions. It is anticipated that this preparation will decrease overall surgeon training time and enhance patient safety. Also included in the lab are a number of haptic hand controller devices for optimization of the force feedback on future generations of neuroArm. The lab will also house three temporal bone dissection stations, providing the ability to compare surgical performance in the real and virtual environments.
The design and manufacture of unique pieces of robotic machinery will be the primary focus of the Advanced Engineering and Prototyping Lab. Challenges in robotic design and implementation will be met by staff and trainee engineers, who will work together to develop concept and replacement components for the robotic systems. The lab will also create an environment that will accelerate research and development, rapidly bringing novel ideas from idea to application.
To test the innovations developed in both the Surgical Performance and Advanced Engineering labs, the Experimental Operating Room was established. It has been designed to mimic the environment of the iMRI operating theatre, thus providing an ideal location to evaluate future generations of neuroArm before integration. In addition, physicians-in-training and surgeons are able to be trained on new equipment and techniques prior to clinical adoption.
An inherent advantage of robotics is the ability to digitize quantifiable data. Experiential knowledge, while useful, is enhanced greatly by objective numbers and digital footage. Testing and experimental surgeries performed in the Experimental Operating Room are able to be shared through the Telementoring and Debriefing Room. Analysis of success and error here will optimize design and reduce the potential for medical error. To reciprocate this, sites around the world that wish to connect to our centre are able to through videoconferencing and digital media transfer.
Project neuroArm seeks to look both inwards, increasing our research productivity here, as well as outwards, to connect with the broader community.
To view a photo gallery of the NeuroArm first case, click here.