A Rush surgeon is the first in the world to use an advanced new microsurgery system to remove a spinal tumor. This breakthrough use of the robotic Symani Surgical System opens the possibility of using it for other complex, extremely delicate neurosurgical procedures.
Microsurgery combines microscopic magnification of the surgical field (the area in the body being operated on) with the use of miniature surgical instruments. It is used for procedures on extremely small body parts such as lymph vessels and nerves. Robotic-assisted microsurgery allows for very precise surgical movements, which can reduce the risk of surgical complications and speed postoperative recovery.
Rush recently acquired the Symani Surgical System to enhance the safety and effectiveness of microsurgeries performed at the medical center. Rush is the first and currently the only hospital in the Chicago area with the system.
Technology enables surgery with added safety, accuracy
The Symani system places a surgeon in front of a video monitor that provides real-time, three-dimensional microscopic images of the surgical field. The surgeon performs the surgery using handheld controls to manipulate surgical instruments attached to robotic arms.
The Symani system’s use of imaging and controls is similar to older robotic surgery systems that are used for minimally invasive procedures on larger parts of the body. However, the Symani system is designed for microsurgery and used for open surgeries — when part of the body is opened with incisions to allow access to the surgical site.
“We term these types of devices enabling technology, technology that enables us to do procedures in ways that are safer, more accurate, more efficient,” said John O'Toole, MD, MS, chairperson of the Department of Neurological Surgery at Rush University Medical Center. “This particular technology offers powerful scaling and stabilization of motion, removing human tremor and aberrant motion. When you’re moving things in a millimeter of space, it allows a great deal of precision.”
The long reach of robotic arms
On April 22, O'Toole used the Symani system to remove a benign tumor from a vertebra (spine bone) of a middle-aged woman. Though noncancerous, the tumor was growing and pressing on her spinal cord, causing pain.
To reach the tumor, the surgical team made incisions in the back of the patient while she was under general anesthesia. “We brought in the robot to perform the microsurgical dissection of the soft tumor,” O’Toole said.
“The tumor was growing from within the bone into the space in front of the spinal cord. While working from the back, we had to reach in front of and around the spinal cord in order to get the tumor out.”
Using the system, O’Toole was able to remove the tumor entirely. The patient, who consented to use of the Symani system prior to her surgery, is doing well and recovering from her procedure on schedule. “Her prognosis is excellent, with very low likelihood of recurrence” of the tumor, O’Toole said.
Old procedures, new and better tools
O’Toole regards the procedure’s success as proof of concept for a range of possible future uses of robotic-assisted microsurgery. “The potential for working with very delicate structures of the nervous system is clearly there,” he said. “We’re really excited to apply this technology to delicate areas of the spinal cord and brain.”
He sees potential for robotic microsurgery to treat abnormal blood vessels in the spinal cord and “potentially even for small brain tumors in very deep and delicate locations.”
In addition, robotic microsurgery can be used to drain lymph vessels that become swollen with fluid. Called lymphedema, the condition can be caused by radiation therapy for cancer and by cancer itself. O’Toole says that it’s an obvious application for the technology, “because these vessels are extremely tiny and fragile.”
He notes that these procedures already are performed at Rush. So are microsurgical spine surgeries that treat herniated discs, spinal stenosis and cervical spine disorders
“It’s the application of this particular technology to these types of procedures that’s novel,” O’Toole says. “Rush continues to place an emphasis on these kinds of innovations that allow us to take even better care of our patients.”
