Robot that simulates arm helps neurological surgery in RS

A private hospital in Porto Alegre performed last Wednesday (10) a neurological surgery with the help of a robot that simulates a human arm. According to Brainlab, the equipment manufacturer, it was the first robotic neurosurgery performed in all of Latin America.

The robot assisted in fixing screws to stabilize a patient’s spine. The 65-year-old man had low back pain that radiated to the lower limbs – that is, when it affects other parts of the body, such as the legs.

In cases like this, the normal thing is to prioritize certain actions before opting for surgeries, such as changing eating habits, physical therapy and medication use, explains Arthur Pereira Filho, neurosurgeon at Hospital Moinhos de Vento and a doctor in neuroscience from PUC-RS (Pontifical University Catholic Church of Rio Grande do Sul).

In the patient’s case, an MRI showed a narrowing of his lumbar spinal canal and a slippage of the vertebrae, called spondylolisthesis.

“That means the patient had advanced degeneration of the spine, where the nerves were tight. He had what’s called spinal instability. It was loose, in layman’s terms, and there was one vertebra slipping over the other.” explains Pereira Filho, who participated in the procedure.

As the simplest measures did not reduce the pain, it was decided to perform a surgery called arthrodesis of the lumbar spine. “It’s a traditional procedure that has been done for many years and is used for numerous pathologies of the spine”, says the doctor.

The surgery consists of performing a decompression of the nerves. In addition, the spine is stabilized by means of screws that are placed in the vertebrae, preventing them from slipping.

The innovation, in the case of this patient, was the use of the robotic arm to help surgeons.

The use of robots in surgical procedures is not new – in many cases, the surgeon manipulates the machine through a control outside the surgical field. But in the case of the robotic arm, it works as an additional arm during the procedure, explains Vinícius Dessoy Maciel, president for Latin America at Brainlab. In addition, the surgeon does not leave the field of operation.

By applying the screws more precisely with the help of the robot, say those involved, the risk of complications and the need for new surgeries is reduced in cases where the implant is not applied in the exact location or when it becomes loose.

For the robot to work, it is necessary to use a second technology: neuronavigation. This instrument reads images of the patient’s anatomy and indicates the exact location where the screw should be inserted.

“Navigation helps me plan the surgical process and then implement it”, says Maciel, who says that Hospital Moinhos do Vento has been applying the technology in neurological surgeries for about 15 years.

Only the implementation of the navigation system can improve patient outcomes, but not so much when used in conjunction with the robot. “If there is no robotic arm, it is possible to use only the neuronavigation system, but the firmness and placement of the screw is not so precise”, explains Pereira Filho.

He says that, in the traditional method, where neither the navigation system nor the robot is used, about 20% of the screws are implanted with a non-ideal positioning. With navigation, this percentage drops to 4%. When using navigation in conjunction with the robotic arm, less than 1% of screws are positioned with some degree of low accuracy.

In the case of the patient treated at Moinhos do Vento, the outcome was beneficial: there were no post-surgical complications and no problems with deviation of the screw implanted in the spine were recorded, according to the doctors. The patient was discharged and, so far, no longer reports lower back pain.

The hospital performed two more surgeries with the robotic arm. Both procedures were considered successful.

price is high

Although they have advantages, the equipment for performing robotic neurosurgeries is expensive – a situation that also occurs with other robots designed for medical purposes.

The average value of Brainlab’s robotic arm is US$450,000, or about R$2.3 million in the current conversion. The browser that needs to be used with the robot also costs about R$ 2 million.

“It’s a heavy investment if we think about the SUS or smaller hospitals”, says Pereira Filho.

For Maciel, from Brainlab, cost analysis requires understanding what technologies represent for the health system in the long term. “Often, the impact of surgeries is not investigated.”

He exemplifies a case in which the application of the screw does not require a new surgery – something that represents more costs and a loss in the patient’s quality of life. With the robotic arm, these cases of operations to review the implant fall, resulting in possible savings in values.