Kumar Ravinder, Dwarakanath T A, Bhutani Gaurav, Sinha S K
Department of Engineering Sciences, Homi Bhabha National Institute, Mumbai, India; Division of Remote Handling and Robotics, Bhabha Atomic Research Centre, Mumbai, India.
Department of Neurosurgery, Tata Memorial Centre, Mumbai, India.
World Neurosurg. 2025 Mar;195:123658. doi: 10.1016/j.wneu.2025.123658. Epub 2025 Feb 4.
Accurate neuro-registration is important as the success of the surgical procedure highly depends on it. This article deals with neuro-registration using tele-manipulation (Master-Slave Manipulation) to facilitate tele-surgery and enhance the overall accuracy and reach of the robot-assisted neurosurgery.
A 6 degrees-of-freedom parallel kinematic mechanism (6D-PKM) master-slave robot in tele-manipulation mode is utilized for both neuro-registration and neurosurgery. Real-time kinematic control of 6D-PKM is made possible by solving its forward kinematics using the trajectory modifier algorithm with an accuracy of 1 μm and 0.001° in translation and orientation, respectively, in real time. The master operator using the 6D-PKM master mechanism moves the 6D-PKM slave robot equipped with a touch probe stylus (4 mm diameter) in tele-manipulation mode. In neuro-registration, the slave is remotely guided to touch the fiducial marker in a predetermined order. A correlation between the medical image space and the real patient space is made to establish the neuro-registration. The accuracy of neuro-registration is validated through experiments on skull phantoms. These phantoms are designed to simulate the neurosurgical process.
The neuro-registration process successfully registers the phantoms, and maximum registration error is found to be 0.6 mm. The accuracy of neurosurgery is validated using several target points in phantom. The accuracy of registration is also verified by robot piercing a 2-mm-diameter surgical needle through a predesignated 3-mm-diameter cylindrical target hole with radial clearance of 500 μm.
Accurate neuro-registration using tele-manipulation has been demonstrated. The overall accuracy of the robot-based neurosurgery is tabulated. This approach eliminates line-of-sight issue and the requirement of an additional unit for neuro-registration. This minimizes the registration time and makes intraoperative registration feasible.
精确的神经配准非常重要，因为手术的成功高度依赖于此。本文探讨使用远程操作（主从操作）进行神经配准，以促进远程手术并提高机器人辅助神经外科手术的整体准确性和可达性。
在远程操作模式下，利用六自由度并联机构（6D-PKM）主从机器人进行神经配准和神经外科手术。通过使用轨迹修正算法求解其正向运动学，实现了6D-PKM的实时运动控制，在平移和方向上的精度分别达到1μm和0.001°。主操作员使用6D-PKM主机构，在远程操作模式下移动配备有触摸探针笔（直径4mm）的6D-PKM从机器人。在神经配准过程中，从机器人被远程引导，以预定顺序触摸基准标记。通过建立医学图像空间与真实患者空间之间的相关性来进行神经配准。通过在颅骨模型上进行实验来验证神经配准的准确性。这些模型旨在模拟神经外科手术过程。
神经配准过程成功地对模型进行了配准，最大配准误差为0.6mm。使用模型中的几个目标点验证了神经外科手术的准确性。通过机器人将一根直径2mm的手术针穿过预先设计的直径3mm、径向间隙为500μm的圆柱形目标孔，也验证了配准的准确性。
已经证明了使用远程操作进行精确的神经配准。列出了基于机器人的神经外科手术的整体准确性。这种方法消除了视线问题以及对神经配准额外单元的需求。这最大限度地减少了配准时间，并使术中配准可行。
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