The ROSA™ Robotic Surgical Assistant

G. Rees Cosgrove, MD, FRCSC, FACS

G. Rees Cosgrove, MD, FRCSC, FACS

Department of Neurosurgery: Director of Epilepsy and Functional Neurosurgery; Residency Program Director

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The biggest question people ask, that is the most confusing to patients: Is the robot doing the surgery? No, it is simply a robotic arm and a very precise positioning platform for tools that the surgeon then uses as an aid to complete the surgery.”

– G. Rees Cosgrove

The latest innovation in our advanced neurosurgical care is the ROSA™ robotic surgical assistant. Dr. Rees Cosgrove, an internationally acclaimed neurosurgeon, joined the staff at Brigham and Women’s Hospital and Harvard Medical School in 2015. He is the first physician at the top ranked hospital to operate using the ROSA™.

ROSA™ assists surgeons in performing minimally invasive brain surgery for epilepsy and other neurologic conditions, in a safer, faster, more effective way.

Below Dr. Cosgrove answers questions and discusses his experience using the ROSA™:

1. What does the device do?
ROSA™ acts as an assistant in the operating room and provides a service to help navigate and map the brain, similar to a GPS. It can be used in any type of cranial or spinal procedure that requires surgical planning with preoperative data and precise position and handling of instruments. It is especially useful for implanting electrodes for epilepsy monitoring but will have many other applications in the future. ROSA™ uses image guidance and provides a stereotactic device that holds surgical tools and allows procedures with image guidance to be done robotically.

Prior to the procedure, the patient will have multiple thin cut CT scans that when stacked properly and joined together create a 3D model of their head. Once this is complete, we take that model of the patient’s head and register it to the actual patient’s head in the operating room. Once they are locked in position, the ROSA™ will scan the surface of the patient’s face creating a precise surface contour of their head. This information allows us to create trajectories for the procedure. The robotic arm then aids the surgical team with its impeccable strength by holding surgical tools precisely and completely still throughout the procedure.

2. When did you first hear about the ROSA™?
The device was first introduced three years ago for more accurate and precise placement of depth electrodes for EEG monitoring in epilepsy patients. Many updates to the software and structure have been made since then. In late June, BWH obtained the ROSA™ 3.0, making us the second hospital in Boston and one of only 23 hospitals in North America to offer this device.

3. What was the process of training to operate with the ROSA™?
I observed multiple surgeries at the Montreal Neurological Institute, where they have a lot of experience using the ROSA™ over the past three years. In addition, a clinical support member from ROSA™ is present in the operation room for the first twenty cases. It is important to keep in mind that this is not a new method, it is just a new tool to perform a current procedure. Therefore, the most important thing is to see an experienced surgeon in epilepsy surgery- the ROSA™ just allows that surgeon to be more accurate and precise than without it.

4. How is this device programmed?
After we have co-registered all of the patient’s images, we choose the entry point and a target. Those two points define our trajectory, once you have entered those two points into the software, ROSA™ knows exactly where they are and will take you along that trajectory.

5. How do you anticipate this device aiding you during future procedures?
ROSA™ will help reduce operating time and invasiveness, and provide a strong steady platform to introduce electrodes, biopsy needles and other surgical tools.

6. How will this change the routine of surgery?
The 3D imaging of the patient’s brain can be loaded into the ROSA™ computer days before any operation. This helps us prepare for the surgery before, by being able to plan out and pin point the exact location and approach to where we want to operate.

7. Why is this considered a minimally invasive procedure?
Surgeons are able to make multiple pinhole sized incisions in the scalp, knowing exactly where to enter the brain with the limits and restrictions programmed during the planning stage, using the patients imaging prior to surgery.

8. What do you think the benefits of using the ROSA™ are?
Accuracy and precision

9. Does the recovery process differ when the ROSA™ is used in the OR?
The recovery time should remain the same in most cases.

10. Do patients need to pay more if they have the robotic surgery?
No, patients don’t incur any additional costs and these procedures will be covered by health insurance.

11. How will you make patients feel comfortable with the idea of a robot helping perform their surgery?
It’s important for them to know the robot isn’t performing the surgery. Rather it is aiding the surgeons. Using the imaging collecting before the surgery, I am able to set parameters that the ROSA™ can access and supply safety zones into the software that are specific to each patient’s case.

12. Do you believe the creation of other robotic aides is in the future of healthcare?
Of course, but I don’t believe they will ever replace us. I like to say: A fool with a tool is still a fool; you need a professional with experience who has been well trained to complete a successful operation.

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