Research Article Integration of a robotic system in the neurosurgical operation theatre Martin Engelhardt 1* , Aleksandra Popovic 2 , Pierre Bast 2 , Wolfgang Lauer 2 , Martin Scholz 1 , Klaus Radermacher 2 , Kirsten Schmieder 1 1 Department of Neurosurgery, Ruhr University Bochum, Bochum, Germany 2 Helmholtz-Institute for Biomedical Engineering, Aachen University, Aachen, Germany GMS CURAC 2006;1:Doc11 provisional PDF Abstract To integrate a robot assisted trepanation system into the neurosurgical operation theatre, requirements of the system have to be addressed. To perform a craniectomy with removal of the pathological calvaria and to insert a prefabricated implant in one surgical procedure, the results of a study concerning the entities, the location and the histological findings of calvarial tumors had to be considered. Furthermore, the small space around the patients´ head during surgery, the work angles in surgical procedures as well as the possible positioning of the robotic system and its design have been analyzed. Sterile and ergonomic aspects have been adjusted and proven to fulfill the requirements of the workflow during surgery. The result is a small hexapod robotic system, which is placed beneath the patients´ head on a replaceable stage, able to reach the majority of calvarial tumors that are typically located around the forehead. The handling of the hardware as well as the software user-interface is appropriate to be integrated into the operation theatre. Keywords: neurosurgery, robotic assisted surgery, craniotomy, workflow Introduction Integration of a robotic system into surgical procedures is an important goal of research efforts for man-machine interlinked systems [1], [2], [3], [4], [5]. An interdisciplinary work group, consisting of engineers and clinicians, supported by the German Research Foundation (Deutsche Forschungs- gemeinschaft SPP1124 „Medizinische Navigation und Robotik“, RA548/2-1), has developed a small robotic system capable of drilling bone [6], [7], [8], proven in laboratory surrounding. The aim of this study was to analyze the integration of the robotic system in the operation theatre fulfilling the different criteria of accurate and sufficient bone milling, sterile workflow, limited workspace, and handling of instruments to perform the craniectomy. The system should be able to accurately remove pathologic calvaria and create a graft for prefabricated titanium implant for coverage. Some other robotic systems which have been evaluated in surgical environments, are more bulky, and space occupying [5], [9], [10], causing difficult integration into surgical workflow. Other obstacles are high costs and the high weight and dimensions of other robotic systems could alter the current workflow or require changes in the operation theatre concerning architecture or general surgical planning [11]. Thus, the developed system should be mobile in the operation theatre and must not interfere with standard procedures, if possible. * Corresponding author: Dr. Martin Engelhardt, Neurochirurgische Universitätsklinik, Ruhr-Universität Bochum, Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Tel.: 0234/299-3602, Fax: 0234/299-3609, eMail: martin.engelhardt@ruhr-uni-bochum.de