Modus V brings robotic assistance to neurosurgery

Modus V may be the first robot assistant for neurosurgeons. Sebastian Koga, M.D., called the robotically controlled digital microscope an extension of a surgeon's vision.

A robotic medical device is acting as an assistant during neurosurgery, a field that robotics have barely entered due to the complex nature of brain and spine-related surgeries.

Sebastian Koga, M.D., medical director of the Neuroscience Institute and chairman of neurosurgery division at Ochsner Health System in Covington, La., uses Modus V, a robotically controlled digital microscope. Without Koga having to lift a finger, the device provides enhanced visualization of the area in which Koga is operating, creating a more efficient method of visualizing a surgical area.

Paired with technology that provides three-dimensional imaging of the brain, Koga called the robotic medical device versatile, noting that it's one of the first of its kind in the field of neurosurgery.

Modus V is derived from robotic arms used on the International Space Station.
Modus V is a robotically controlled digital microscope that was built using some of the same technology that was used in the Canadarm on NASA shuttles.

Modus V enhances visualization

Modus V, built by Toronto-based medical device company Synaptive Medical Inc., is a robotic arm that tracks surgical instruments to automatically move its high-powered microscope to an area the surgeon is working on.

The device, partially derived from a series of robotic arms built by Canadarm that were used on the International Space Station, is located near the head of the surgical bed directly over a patient's brain or spine. The microscope's focus is then projected onto a screen for the surgeon, providing greater magnification, according to Koga.

"The robotic arm is going to extend our vision by having higher light, higher resolution, higher magnification," Koga said.

Synaptive developed the device based on feedback from 5,000 procedures. It can perform intuitive functions, such as zooming in or out and moving optical access. One of the key benefits of Modus V is that it removes the surgical microscope from the operating room, Koga said, which is typically a challenging, bulky piece of equipment located directly between the surgeon and the patient's brain or spine.  

"You're looking straight forward at the screen and have the robot move to the different angles you need rather than the surgeon trying to change posture or crouch at awkward angles," Koga said.

Modus V is part of Synaptive's BrightMatter platform, which Koga has been using for the last two years. The platform not only includes the robotic medical device, but also MRI software for diffusion tensor imaging to map white matter tracts in the brain. The platform's software can also build a three-dimensional map of the brain's neural connections, which provides a new way of visualizing the brain in the operative setting, Koga said.

Koga said Modus V leads to improved ergonomics and surgical workspace, while the BrightMatter platform enables better planning and navigation during surgery, showing the exact position of the instruments in the brain in relation to anatomical structures.

"You can see side by side where you are in the brain, see what important structures you're next to or want to avoid, see where the tumor is, but the surgical act is still a manual procedure," Koga said.

Modus V enhances visualization during neurosurgery.
Modus V is a robotically controlled digital microscope that provides advanced visualization during surgeries.

Robotic medical devices in neurosurgery

Koga said neurosurgery has been a difficult field for robotics to enter -- and for good reason.

"The operations are not along straight paths. They're along circular corridors that follow the enfolding of the brain," he said. "And those folding patterns of the brain are something determined by millions of years of evolution and not easily predictable in algorithms." 

Robotic medical devices have been known to assist in other types of surgeries, such as the da Vinci Surgical System robotic technology for prostate surgery, but Koga said that to his knowledge, Modus V is the only one for neurosurgery on the market.

We've seen the evolution of this product and really believe that this level of automation is going to decrease the workload in the operating room.
Sebastian Kogachairman of neurosurgery division, Ochsner Health System

Koga said Modus V offers a safe approach to the introduction of robotic assistance in neurosurgery by focusing solely on visualization.

"The robot is not doing anything to the tissue except shining light at this point, so it's a safe place to start in brain robotics," he said. "But that's also a vital and complex thing because the whole procedure is predicated on correct visualization."

Modus V helps create a seamless marriage between a surgeon who's focused on performing the operation and a machine that's enhancing the surgical field on a screen, according to Koga.

"We've seen the evolution of this product and really believe that this level of automation is going to decrease the workload in the operating room," he said. "That's the reason behind these investments today. It's not just scientific advancement, it's really patient safety. And the patient safety culture is closely linked to the workload of the surgeon and the staff."

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