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IOWA CITY -- The University of Iowa’s surgical treatment of epilepsy used to start with a razor — as patients had to shave their head so physicians could make large incisions in the scalp, peel away pieces of the skull and cover the brain with electrodes to determine where the seizures were coming from.
The procedure could last from 7 a.m. to 7 p.m. And the recovery was longer with patients stuck in intensive care for days, battling pain and swelling of the scalp and eyes, among other things.
But UI Health Care recently became the first in Iowa to acquire a minimally-invasive robotic surgical assistant that’s proving to be a game-changer for patients and surgeons alike.
“It’s quite incredible actually,” said UIHC neurosurgeon Brian Dlouhy, whose patients include children with epilepsy.
The university obtained its first and only ROSA robot — which stands for Robotized Operating Surgical Assistant — this spring, and Dlouhy said he’s used it on a handful of patients so far. But they’ve had vastly different surgical experiences than their pre-ROSA predecessors, Dlouhy said. For starters, they didn’t have to shave their heads.
“That’s incredibly important for someone's morale going through a surgical procedure and after for their recovery,” he said. “I do mostly kids. So for teenage girls, imagine how much of a benefit that gives you.”
The patients also didn’t have to endure large incisions in their scalp and skull. Instead, the robotic surgical aid uses “extraordinary” precision to place electrodes on the brain using a 2-millimeter drill bit to puncture through the scalp and then the skull and then the covering of the brain.
“It allows you to place electrodes in places you never would have been able to place them before because of the accuracy and precision,” Dlouhy said. “So it’s more precise, more effective, less pain and faster recoveries.”
ROSA patients are under anesthesia only a few hours, and experiencing less head trauma, making them capable of conversation or watching TV, for example, a short while after waking.
“The old way, I’d wait a couple of days before they could recover and wake up and then have that kind of conversation, because there’s swelling of the scalp and swelling of the eyes,” he said. “They’re in a lot more pain.”
Origins of ROSA
The French robotic design company MedTech in 2007 developed ROSA to help surgeons perform brain and spinal procedures. The U.S. Food & Drug Association approved the ROSA spine robot in 2016 and the ROSA brain robot in 2018, according to MedTech.
Costing about $700,000 each, the robots are in more than 150 hospitals and clinics worldwide. They have a robotic arm with “six degrees of freedom, allowing exceptional dexterity and flexibility,” according to the company. The arm coordinates with a computer “brain” that uses laser sensors and acts like a GPS, enabling surgeons to make three-dimensional maps of the brain to guide surgical equipment.
Although UIHC so far has used its ROSA for the procedure to localize epileptic seizures, UIHC’s neurosurgery department in the coming months plans to expand its use to other brain surgeries — like deep brain stimulation to treat various neurological conditions, laser interstitial thermal therapy to treat tumors; and biopsies.
And Dlouhy believes the technology has laid the groundwork for more progress in his field.
“It’s definitely the way the future,” he said. “I would see more and more surgeries using this over time. It's going to replace a lot of things that we currently do.”
That could be good for his own mental health — given the extreme precision required during his many hourslong surgeries. When asked whether ROSA has ameliorated his stress levels, Dlouhy said, “1,000 percent.”
“I’ll live a lot longer because of this,” he said, sharing more about the mental anxiety of trying to miss key blood vessels in the brain. “If one of those bleeds, then there can be a large stroke in the brain. And we're talking a millimeter. So the precision is absolutely critical. And a robot that provides that kind of precision, that's just irreplaceable.”
Surgeons still have to be extremely precise and focused. But the technology provides extra insurance. And that’s reassuring for patients and families, too, he said.
“This kind of technology makes things like neurosurgery, which has always historically been extraordinarily challenging, extraordinarily stressful, and so fraught with if one thing small thing happens a horrible complication … It makes those things less common. And provides a lot more confidence.”
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