Robotic Surgery Tool Guides Neurosurgeons at UH Cleveland

By Samantha McGrail

– Medtronic recently selected University of Hospitals (UH) Cleveland Medical Center as the second site for its Stealth Autoguide cranial robotic surgery guidance platform for neurosurgery.

The system aids the spatial positioning and orientation of instrument holders used in neurosurgical procedures.

The surgical tool can be used on adult and pediatric patients suffering from various neurological conditions. The first time experts used Stealth Autoguide on a UH patient was mid-November. 

“Medtronic chose us based on our experience in precision, minimally invasive approaches to brain tumors,” Andrew Sloan, MD, director of the brain tumor and neuro-oncology center, as well as the Center for Translational Neuro-oncology at UH’s Neurological Institute and the Seidman Cancer Center, said in the announcement. 

With Stealth Autoguide, a surgeon can place an electrode or catheter in the brain or perform a biopsy with the help of a robot, which allows for accuracy in movements, while simultaneously receiving visualization and feedback through a computer system, the press release stated.

Sloan noted that previously, UH leveraged Laster interstitial thermal therapy (LITT), which is a technique used to treat primary and metastatic brain tumors that are hard to reach with traditional surgery.

Additionally, LITT can help with clinical trials for glioblastoma (GMB), including a trial testing the poliovirus against brain cancer. 

“The Stealth Autoguide provides us with an important, innovative tool to use for intricate brain procedures,” said Nick Bambakidis, MD, director of the UH Neurological Institute. “This system enables us to precisely and reproducibly target lesions deep within the brain.”

Implementation of the robotic surgery platform will also benefit patients by allowing providers to perform neurosurgeries without shaving the patient’s head. The technology also negates the need for a large stereotactic headframe, which is generally needed for specific brain procedures and surgeries. 

At the end of 2019, Medtronic received FDA clearance for its Stealth Autoguide. 

Specifically, the system was cleared for use in biopsy procedures, stereoelectroencephalography (sEEG) depth electrode placement, and for positioning the Visualase bone anchor in catheter placement.

“This technology delivers on the promise that University Hospitals Seidman Cancer Center will lead the region by providing leading edge surgical procedures and outstanding patient outcomes,” said Ted Teknos, MD, president of UH Seidman.

“Robotic technology has revolutionized the field of minimally invasive surgery in many parts of the human body and the central nervous system is one of the last frontiers,” he stated. 

Over the past two decades, robotic cancer surgery has seen a significant increase in adoption across clinical specialties.

A February study of 15,893 patients who underwent five major cancer surgery procedures found that robotic cancer surgery was appealing from a patient’s perspective due to the lower out-of-pocket costs compared to open surgery.

Specifically, the largest disparity was for partial colectomy, totaling $4,620 for open surgery and $3,435 for robotic surgery, a $1,140 difference between the two approaches. Length of stay also saw a 0.94 percentage point decrease in the study period.

And hospitals are continuing to adopt the innovative, expensive surgeries despite a recent FDA warning calling on providers to not use robotic surgery for certain procedures given a lack of evidence on risks and benefits. 

For example, the use of surgical robots can result in injury, unexpected complications, or possibly poorer long-term patient outcomes. And oftentimes, these systems might not provide accurate feedback, causing adverse events to take place. 

Brigham and Women’s Hospital researchers believe that patient demand is to blame. 

“A key reason why hospitals are willing to absorb the high up-front costs of robotic surgery is patient demand,” the study highlighted. “Investigators have shown that institutions acquiring surgical robotics have seen a dramatic increase in their surgical volume.” 

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