Robotics & Image Navigation

Closing the Loop

Surgical robots and image navigation systems are highly precise, but they cannot tell what tissue they are touching, and they are blind to nearby nerves. Neurointellect's smart sensing instruments read tissue type, tissue condition and nerve proximity at the instrument surface. That real-time feedback closes the loop, and it can also help correct the drift and registration errors that are among the biggest hurdles for image navigation.

Application 01 · Medical

Smart Sensing Surgical Robotics

A surgical robot positions an instrument from images and a plan, but it receives little information about the tissue the instrument is touching. TCP and nerve localization add that information at the end effector: the instrument reports the tissue at its tip and the direction and proximity of nearby nerves, as live inputs the robotic system can use during the procedure.

TCP at the end effector: tissue type at the instrument tip

Nerve direction and proximity available to robotic guidance

Tissue targeting and avoidance during the procedure

Robotic arm positioned over a patient in an operating room

Instrument surface · live

Tissue type

Nerve proximity

Nerve function

Application 02 · Medical

High-Resolution Nerve Localization

Tissue identification tells the instrument what it is touching. Nerve localization is a separate function: it finds where the nearest nerves are, in which direction and how close.

The animation shows a minimally invasive transforaminal endoscopic lumbar discectomy. Compared with open microdiscectomy, endoscopic lumbar discectomy has been associated with higher rates of nerve root injury and postoperative dysesthesia.^1,2 The exiting nerve root lies at the edge of the working corridor and cannot be seen on fluoroscopy as the instrument is placed; one series reported exiting root injury in 20 of 233 patients.³

Here the exiting nerve root is mapped at high resolution and shown on the AP and lateral images, so the surgeon can make small changes to the trajectory and establish a safe corridor to the disc space, knowing where the root lies relative to the instrument.

1. Bombieri FF, Shafafy R, Elsayed S. Complications associated with lumbar discectomy surgical techniques: a systematic review. J Spine Surg. 2022;8(3).

2. Yang CC, Chen CM, Lin MHC, Huang WC, Lee MH. Complications of full-endoscopic lumbar discectomy versus open lumbar microdiscectomy: a systematic review and meta-analysis. World Neurosurg. 2022;168:333–348.

3. Choi I, et al. Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety. Eur Spine J. 2013;22(11):2481–2487.