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The Glasgow Neurosociety
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in association with SI, or Surgical Neurology International, and SI Digital are happy to present
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the abstracts and discussion of the 10th anniversary Glasgow Neurosociety meeting held in November of 2022 in Glasgow, Scotland.
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Hassan Ishmael is president of the Glasgow Neurosociety at that time. He's from the Wolfson School of Medicine at the University of Glasgow in Scotland and the United Kingdom
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Faculty commentators are Likith L. Akhandi, who's the consultant neurosurgeon at the Queen Elizabeth University Hospital in Glasgow
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And Amy Davidson, a neurologist, also at the University of Glasgow, also at the Institute of Infection, Immunity, and Inflammation in Glasgow, Scotland.
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Other Glasgow neuro hosts were Alidith Middleton, Vice President of Glasgow neuro,
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and Edica Choudry, another Vice President of Glasgow neuro. Hi, everyone. Welcome back to our panel discussion Our next speaker is Avi Jolte, and she'll be talking about her poster, recent
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advancements in robotic skull-based neurosurgery, a review. Oh, and over to you, Agi. Hi. Thank you. So hi, everyone. So my project primarily focused on robotic surgery and its potential to
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overcome the limitations of an endoscopic endo-nasal surgical approach. So for any mid-line skull topologies, the endoscopic endo-nasal approach is the current standard surgical approach. However,
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it has certain limitations, such as constraint, sino nasal corridor, a need for a second surgeon, the lack of sufficient dexterity to close large skull-based defects and so on. But robotic
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surgery could have become these limitations. So what I did was I conducted a review with the aimed to identify recent advancements in robotic skull-based neurosurgery. And I chose studies from 2018
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up till 2022 So a five-year time period. And I used the Prisma guidelines to generate six studies for data extraction. So ultimately the recent advancements in robotic surgery that were identified
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included
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five robots. So they will concentric tube robot and robotic handles. The endoscopic robot, the micro continuum robot, the versus robotic system and also the semi-autonomous integrated robotic
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system using the Raven to surgical system. So individually, each of these robots had their own advantages and limitations. But as a whole, the advantages were improved performance, benefits in
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lengthy interventions and deep corridors, and also higher dexterity and safety and also modularity. And as
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a whole, the limitations were mostly requiring re-design and also requiring validation of their reliability. So to conclude, I did a review, and I found out that there were five recent
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advancements in the particular surgery, and also my review pointed out the advantages and also the limitations of these five systems.
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Thank you.
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Thank you. Sorry I am happy for you to
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take the lutee to your mr alli county i'm the you know, very interested. Yeah, just two questions. You know, I think this is a very rapidly evolving and developing field. So between the years to
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18 and 22,
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with these robots kind of sequentially identified over, they all in the same era or generation. So some of these robots, for example, the Raven II was in for quite a before this. But what
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happened was they sort of used the Raven II, which was, which was previously here before 2018, and they added like a semi-autonomous system to it. So in terms of like modularity, they added a
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camera and a scope and try to make it semi-autonomous. So some of these systems were already there previously, but what they did was they modified it. So in terms of like sequential-wise, there
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isn't a sequential to it, so they were sort of there already. Because, you know, in anybody who's going to invest in a robot or an advanced, you know, engineering innovation, you're waiting for
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the optimum time to purchase it because it's a huge investment. There are two issues here. One, when do we know you have peaked in technology, we never peaked in technology Secondly, how do you
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identify a cost effectiveness and what your studies, have you studied, identified any aspect of this side, which is very, very important in the UK medicine? There are
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two questions. Sorry, I've asked you in a row, but did you get the two questions? Yes, it was about cost and the right. What is about cost effectiveness and one went to know when to buy? Right.
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So I feel that because for most of the studies, they were mostly prototypes and they required like, because they did also feedbacks from surgeons as well who use these robotic prototypes. And some
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of them required a redesigning as well. So in terms of optimal timing to purchase it, I would feel that the ones which require redesigning, for example, the robotic handles, it's not time for
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them yet. But I feel that they're sort of moving towards the direction where they're creating a proper system. So like my favorite one would be the semi-autonomous one because it's sort of
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integrating AI into it and also using surgeons, knowledge as well, sort of combining both of them. But in terms of cost and optimal time, I feel like in terms of cost, I wouldn't much mention
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about cost. They did compare the versus system and also the DaVinci system and mentioning that the versus system had a smaller footprint than the DaVinci system but not much, of course. So I'm
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thinking that for future studies,
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slightly larger scale studies comparing different robotic systems and ultimately identifying the best system available.
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Okay, thank you very well and a good
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quick look at here. My question might be a bit more of a, I just want to ponder all these advancements are great and when you were reflecting there you thought that the best mechanism was one that
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could utilize like the surgeon's skills and I guess I mean this might be one for Mr. Alchandi as well, like robotics moving on safer practice is good but is there ever a worry that we're going to
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de-scale the surgeons or is this always a good thing to bring robots into the operating theatre and as a lowly neurologist I should just stay in my lane.
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Well, that's just a good question. I always feel that you know in medicine especially it's important to have the human touch so I feel that there's always a need for surgeons that and we do require
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the surgeon to be in the operating theatre but because in terms of technology it has made our lives so much more easier in this last few decades. So I do feel that with integrating artificial
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intelligence and combining the surgeons knowledge as well, there
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could enhance patient safety in
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a long run. But of course, I'm not a professional in artificial intelligence and how it works as well. So I think there should be some sort of like a discussion between like the computer scientists
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and also surgeons in the future in terms of creating something better and something which could enhance patient safety as well. And also make certain slides so much more easier.
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Thank you. Thank you.
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Lovely. Actually, I have a question. Mr. Alacanti, do you have any experience with the expansion of robotics in neurosurgery in general, not just in skull base or any perceptions on it? So um.
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you're recording this because this is,
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we have two robots in use in your research team. One is a da Vinci robot we use for
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the DBS. So when you say robot, it's not doing a job of a surgeon, it's making it more accurate.
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So the surgeon has to plan the target and everything. So we just, the robotic arm does it. So it is in a way replacing the
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brain lab navigation. So instead of us adjusting the the coordinates of robotic arm does it. The second robot which we are trialing now and
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it's again for spine. It is similar to the navigation system we used to put the exclusion, but instead of us calculating the coordinates and It's got a robotic arm, which actually puts the screw in,
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and we just have to turn the screw. So at the moment, it's not AI, it's not
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doing its job, it's just guiding the surgeons. So surgeons are still doing the job and doing planning, trajectory and everything. So that's why I asked this question. There are different stages
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of robotic advancements, you know, starting from a basic accuracy guidance to motor guidance, you know, where you reduce the tremors and movements to
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the third level, which is completely AI. So surgeons just have to sit and watch and make sure that they don't make a mistake. So those levels, you know, that's a level. And where do we kind of
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feel comfortable from, you know, from what Amy said about discoloring yourself and losing your job? to where the patient safety come into bed. So like Aggie said, it's the most important thing at
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the end of the day is patient safety. So if I think so, it's somewhere in the middle,
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not completely AI, not just because the what we have in the brain lab and neuro navigation is not very different if you have a robotic to do the extra bit of edges in the corner, you can do it
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yourselves So it could be somewhere in the middle, in laparoscopic surgeries, I have seen people do it is actually where you have
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the instruments being helped by surgeons. So you're actually finessing the movements as opposed to accuracy, which is what neurosurgeons use. Yeah. That's really interesting actually. And I guess
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I know Dr. Davidson in neurology, Is there any drive for anything like this neural in the neurology field, although, you know, and not just in terms of, I guess, robotics, but in terms of any
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of these, this sort of future wave of, I guess, the next best thing of technology driven
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topics, whether that be robotics or AI sort of thing. I mean, I think there certainly would be, I mean, I think, I mean, Mr. Alacandy offered the version, there's the one that we kind of work
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closely with in the New Surgeons as DBS and Parkinson's and Intremers. So we often kind of take advantage of our neurosurgical colleagues in that respect to try to try and help with these things. So
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I definitely, you know, we're going to see all kinds of, I guess, kind of joint working within your resurgence from, you know, as we move forward in neurology. And I think, you know, as
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neurologists, we'd be quite happy to piggy back on to these kind of things as to come up
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Absolutely. And I guess, Aggie, I guess a final question is, do you do you think from what you've seen, do you think it's the future?
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Well, as whole, yes, I think it is sort of moving to it's there, like we are dependent, not depending, but we could potentially be depending on robots, how about like what
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So,
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I suppose in the future, there would be AI as well, and we are definitely moving towards that direction, but we're definitely not there yet. There's still room for improvement. So yes, we're
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definitely moving towards that direction.
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Fantastic. And any other final comments from yourself, I guess, before we wrap up. No, but thank you for having me here It's a pleasure. Wonderful. Thank you. And thank you, obviously, for
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coming. It was a really interesting talk. Thank you. We hope you enjoy these presentations.
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