Novel Technique for Robotic-Assisted Protection of Intraoperative Aneurysm Rupture during Surgical Clipping

Intracranial aneurysm clipping is a complex surgical procedure with the looming complication of intraoperative rupture. It can be difficult to control the ruptured aneurysm when this rare but devastating event occurs, given the limited field of view under the microscope, excessive hemorrhage, and need to visualize proximal artery for safe temporary clipping. Presented here is the first known use of a robotic arm as a protective device against intraoperative aneurysm rupture (IAR). Two cases are detailed in which the proximal artery was initially dissected to the M1 branch with a temporary aneurysm clip loaded onto a robotic arm over the artery, acting as an emergency gate. A single button would be pressed in the event of IAR for achieving hemostasis instead of significant suctioning, packing, and further dissection of proximal artery. While the initial cost of the robot can be limiting, the robot use per case is cost- and time-efficient, with minimal set-up and space required. The two cases presented here demonstrate the feasibility and relative ease of use of robotic arm for safeguarding intracranial aneurysm clipping and circumventing the risks carried by prophylactic temporary arterial occlusion. One elective middle cerebral artery (MCA) aneurysm was successfully clipped with the robot in position throughout the case which was completed in less than three hours. A second case of a patient presenting with a subarachnoid hemorrhage from a ruptured MCA aneurysm was successfully clipped with the robot in position over the proximal MCA throughout the case and no significant adjustments of the robot needed intraoperatively. Both cases were completed without IAR nor any complications during the surgery. The intraoperative use of the robotic arm was not interfering with the microscope and positioned to not interrupt any surgical flow as seen in [Fig. 1]. These two cases present the first known robotic use in intracranial aneurysm clipping surgery.

Fig. 1

Publication History

Article published online:
12 February 2021