The Dawn of Robo-Nano Neurosurgery.

Although it is one of the youngest fi elds of medicine , neurosurgery seems to be around for centuries. According to archeological evidence, surgery on the skull is over 10,000 years old 1. In the ancient Egypt, neurosurgery was performed 2000 years BC, as shown in the Edwin Smith Papyrus 2. In the 19 th century, neurosurgery was associated with vast mortality. It was during the 20 th century that neurosurgery has achieved important improvements to both technique and diagnosis. Neurosurgery is the fi eld of medicine where advanced technology feels at home, adapting new techniques and devices in an eff ort to increase the effi cacy and safety of brain and spine surgery. Among these recent advances are surgical robotics and nanotech-nology. Th e use of a mechanical device, automated or with remote control, in order to manipulate the instruments directly in contact with the patient represents a relatively new procedure 3. Robotic technology has been incorporated into stereotactic and endoscopic procedures and is used in robotized microscope, telepresence, and tumor resection 1,2,4-6. Technically, surgical robots can be divided into passive and active systems. A passive system is the one in which the surgeon provides physical energy to drive the surgical tool 7. An active robotic system is the one in which the robot actively interacts with the patient, allowing more complicated motions and the surgeon has the ability to supervise and intervene when necessary 8. Surgical robots can also be classifi ed according to how the surgeon interacts with them. Th ey are divided into supervisory-controlled system, telesurgical system , and shared-control system. Since Kwoh et al. attempted a robotic brain biopsy in the late 1980s, interest in this fi eld and its potential clinical ben efi ts has grown 8. Neurosurgery has defi ned concepts of manual microsurgical techniques and these are already embedded eff ectively and successfully in standard practice. Th erefore, integration of surgical robotics represents an interesting dilemma. Although its theoretical advantages seem most suited to neuro-surgical disease, the state of the art has not yet matched the theory 9. Several robotic solutions have been developed to address the specifi c challenges associated with interventions on the brain 10,11. Th e NeuroMate robotic surgical system was the fi rst Food and Drug Administration (FDA) approved robotic device for neurosurgery 10. Th e Minerva neurosurgical robot followed. Both systems involve a passive robotic arm which …