Gregory Fischer

Image-guided surgery is a paradigm wherein instruments or therapies are precisely placed at specific locations within the body based on medical imaging, and often localized by intraoperative tracking systems. Conventionally, an MRI of a patient guides a thorough pre-operative planning effort, and at the time of surgery that plan is registered to the patient. However, the inherent mobility of soft tissue targets during surgery poses a significant challenge, rendering intra-operative imaging ‘stale’ and potentially unknowingly compromising the alignment of instruments with respect to the actual anatomical locations.

This presentation addresses this critical issue by exploring the potential of intra-operative MRI to actively track soft tissue targets and instruments in real-time. The incorporation of traditional robotic systems into the MRI environment has historically been challenging, limiting the feasibility of this approach. The talk will delve into innovative solutions devised to ensure precision motion safely within the MRI scanner without compromising image quality. By overcoming these challenges, a new era of “closed loop medicine” emerges, wherein instrumentation, anatomical targets, and other structures are dynamically tracked, allowing for interactive optimization of motion planning and instrument delivery.

Compelling case studies will be presented, including an MRI-compatible cooperative surgical robot designed for image-guided prostate biopsy that autonomously steers the needle tip based on live imaging, accommodating unmodeled motion and enhancing the accuracy of the procedure. Additionally, the talk will showcase an MRI-compatible stereotactic neurosurgery robot capable of accounting for brain shift during surgery and facilitating precise delivery of neurostimulation leads, drug delivery catheters, and needle-based ablation instruments for conformal brain tumor ablation, leveraging real-time MR thermometry.