San Raffaele: the first brain surgery with a robotiscope

The surgery was performed on a patient suffering from meningioma, a benign neoplasm. The operation, lasted just over an hour, was carried out with a unique technique in the world panorama, based on the use of a robotiscope, a microscope-robot controlled remotely thanks to the movements of the surgeon's head.

The technology, which has just arrived in Italy at the San Raffaele Research Hospital, is composed of two main tools:

• a high-precision robotic arm, at the end of which cameras are mounted and transmit three-dimensional video images in real time;
• a helmet (Head-Mounted Display, HMD), worn by the surgeon with 2 built-in micro-screens for viewing the operating field and remote management of the robotic system.

The surgeon can guide the robotic arm with small and simple movements of the head, thanks to sensors and accelerometers located in the helmet.

In recent years, neurosurgery has made huge steps forward in the treatment of brain tumors. To date, the use of optical magnification instruments such as the microscope is considered fundamental. Professor Mortini explains:

“The robotiscope has multiple advantages in magnification of the operating field. In particular, surgeon can act continuously (without interrupting for the adjustments of enlargements or focus) thanks to the special technology that allows you to change all the settings of the device with  simple head movements that are transformed into movement of the robotic arm and of the high-resolution three-dimensional cameras. We started by operating a meningioma, but this new technology will be applied in the whole field of neurosurgery with a significant reduction in time of the operation, greater precision, all for the benefit of patients”.

Meningioma is a tumor that originate from the meninges, membranes consisting of three overlapping layers:

• the dura mater,
• the arachnoid,
• the pia mater.

Neoplasm that originate from these structures represents about 15-20% of all brain tumors, usually appears as benign, slow-growing and mainly affect middle-aged women. If the tumor is small, the patient is kept under observation and monitored through instrumental tests (MRI) to document the speed of growth.

If major symptoms and an increase in tumor size occur in the short term, a neurosurgical treatment is required. This type of benign neoplasm rarely invades the surrounding nervous tissue, so surgery with complete resection of the tumor allows full recovery.