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Robotic arms lend a healing touch: neuroArm and its legacy

"Where the robot entered my head," says 21-year old Paige Nickason, the first patient to have brain surgery performed by a robot as she points to an area on her forehead. "Now that neuroArm has removed the tumor from my brain, it will go on to help many other people like me around the world." (Credit: Jason Stang)

The delicate touch that successfully removed an egg-shaped tumour from Paige Nickason's brain got a helping hand from a world-renowned arm—a robotic arm, that is. The technology that went into developing neuroArm, the world's first robot capable of performing surgery inside magnetic resonance machines, was born of the Canadarm (developed in collaboration with engineers at MacDonald, Dettwiler and Associates, Ltd. (MDA) for the US Space Shuttle Program) as well as Canadarm2 and Dextre, the Canadian Space Agency's family of space robots performing the heavy lifting and maintenance aboard the International Space Station.

neuroArm began with the search for a solution to a surgical dilemma: how to make difficult surgeries easier and impossible surgeries possible. MDA worked with a team led by Dr. Garnette Sutherland at the University of Calgary to develop a highly precise robotic arm that works in conjunction with the advanced imaging capabilities of magnetic resonance imaging (MRI) systems. Surgeons wanted to be able to perform surgeries while a patient was inside an MRI machine, which meant designing a robot that was as dexterous as the human hand but even more precise and tremor-free. Operating inside the MRI also meant it had to be made entirely from safe, MRI-compatible materials (for instance, ceramic motors) so that it would not be affected by the MRI's magnetic field or, conversely, disrupt the MRI's images. The project team developed novel ways to control the robot's movements and give the robot's operator a sense of touch via an intuitive, haptic hand-controller located at a remote workstation—essential so that the surgeon can precisely control the robot and can feel the tool-tissue interface during the surgery.

Since Paige Nickason's surgery in 2008, neuroArm has been used in the initial clinical experience of 70 patients who were otherwise inoperable. In 2010, the neuroArm technology was licenced to IMRIS Inc., a private, publicly traded medical device manufacturer based in Winnipeg, Manitoba, Canada, for development of the next-generation platform and for wide distribution under the name "SYMBIS Surgical System."

neuroArm (Credit: NASA)

IMRIS is advancing the design to commercialize minimally invasive brain tumour resection procedures, which allow surgeons to see detailed, 3-D images of the brain as well as use surgical tools and hand controllers that allow the surgeon to feel tissue and apply pressure when he or she operates. SYMBIS has been undergoing calibration, testing and validation at Dr. Sutherland's research facility since March 2015. SYMBIS is expected to be able to perform microsurgery and stereotactic biopsy within the bore of the magnet while real-time MR images are being acquired. The system is more compact, with improved haptics, safety no-go zones, motion scaling and tremor filters. SYMBIS is currently being reviewed by the FDA, and once approved, the system will be made available commercially for other centres worldwide to establish its clinical efficacy through clinical trials.

In collaboration with the Centre for Surgical Invention and Innovation (CSii) in Hamilton, Ontario, MDA is also developing an advanced platform to provide a more accurate and less invasive identification and treatment of breast tumours in the MRI. The Image-Guided Autonomous Robot (IGAR) will provide increased access, precision and dexterity, resulting in more accurate and less invasive procedures. IGAR is currently in the second phase of clinical trials in Hamilton, Ontario, Canada, and Quebec City, Quebec, Canada.

IGAR: Canadian Space technology helps breast cancer patients (Credit: Canadian Space Agency) (Transcript of the video entitled "IGAR: Canadian Space technology helps breast cancer patients")

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