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What is your view on the progress of robotics surgery in the future?

I thought about that a little bit. You are not talking to an expert about robotics. An immediate disadvantage about robotics is the chemical to be put into the patient which are dangerous to the surgeon and to the whole surgical team. So they gave a high radioactivity of some kind. I can’t imagine that there would be chemical so tough that surgeons cannot handle them. At the moment we do not use anything with high enough radioactivity that would be that dangerous. But there are reactive substances occasionally that have been injected deep into the brain for one reason or another. Some of it in very old fashion, in fact, that does not seem to be a field of high promise in the sense that they are actually putting into the tumor or whatever else in the brain. The approach is to kill the tumor. So then the only remaining question I think, is might the robotic offer some accuracy that otherwise cannot be achieved. And I can think it that robotics might in theory just as accurate but not more so. But for putting a probe deep into the brain and into deep central pocket, you probably get a robotic arrangement for that because we are partially mechanized now. Whether somebody out there is doing that or researching it, I can’t tell you. I think that if it really comes onto the scene I’ll know. On the other hand so much of neurosurgery or any other surgery involves abnormality that even the shapes produced from modern imaging techniques are a little bit hard to understand. And a lot of the difficulty relates even to normal variations and probable variations. Structural, three dimensional variations. Well, it’ll be hard to program a robot. For a neurosurgeon and other types of surgeon as well, no matter how long you practice, you will run into variations that you’ve never seen before. Now variations are not a big thing, but if you are not careful and do not take that into account, you will do damage. If you are trained enough you can sort of go with the flow and find the variation. But I am not talking about making any mistakes. But I don’t see that, the judgment, the experience, how you can program that into a machine. You will need a highly sophisticated machine. Now, having said all that, you are talking to a 66 year old guy who has just stopped practicing. And I am not involved in this research. I wouldn’t be aware of real cutting edge, so may be there are things out there that are beyond the difficulties that I have just discussed.

When you are a practicing surgeon, do you think that there’s anything you can’t do that a robot may be able to do?

The things that I have trouble with involve finding things I don’t anticipate despite all the information I know exist. How can I program robot to solve things that even I do not know anything about?

You mean the abnormalities that arise during the procedure?

Yes. I have the advantage of doing my training before any imaging technology comes along. Indeed, CT-scan came out in ‘73 and I finished my training in ‘74. And within a few years CT-scan began to appear everywhere. So I have known neurosurgery without all these computerize imaging.

What are some examples of these abnormalities that arise during the procedure that you can’t predict before hand?

Well, there’s an infinite amount of them in the surgeon’s point of view. Are you aware of the twins separated in New York? Do you remember that case? Well, that was done for the twin, and they had all the advantages of modern imaging. They even took images of the fetuses. They had state of the art, highly studied imaging, and yet when they did the final measure, they found brain connections between the two children that have not been apparent in imaging despite the very high quality of the imaging they had in the intense study that they gave to the multi-state procedure. Despite all that, in a way that it was a bit of surprise, that when our technology is better, that they ran into a piece of brain that is shared between the two where there is no separation, which [the separation] they had thought existed. Now this is an example of what the variation I talked about. After all, the twin case is quite rare. Despite all the study, the surgeon has to decide what to do.

Do you think that imaging techniques that are even more accurate that those used today can allow you to predict some of these variations?

Well the common thing to do, really, in the head, is to find variations of vascular anatomy such as artery or vein. The danger is to damage vessels you cannot anticipate or identify, either artery, since it is under high artery pressure, and veins, which are not under high pressure but they can leak all over the place. You cannot lose a lot of blood. Even if you can, with so much blood all over the place, the surgeon can’t see a thing. You have to stop it. There are no two vessels that are perfectly alike in the brain and in the spine. Then there are also abnormalities in the veins or arteries in the head.

There are abnormalities. Now no two vessels are exactly alike. You can classify them. They are similar but every time you look at these things, there will be a difference from the things you see before although probably not usually, quite much.

But you see that it is hard to program a machine to be able to make those judgmental decisions. How do you program them to deal with things that even you know nothing about? So far there are machines that can work independently but I will be worry about it. So a lot of that kind of work, I don’t see how robotics can do it.

If it turns out that there are things we wish to implant that are particularly deep in the brain… There are systems out there now that are usually used to implant things. Those systems are usually more useful, less dangerous, and more accurate. Those are used on structures. They do not work well on the surface, not because they are not accurate, but because there are veins and arteries on the brain that you don’t know where they are. I guess robotics procedure can be used if you have a good imaging of the structure we could program the robot to implant things. But what you lose from that is that if I have a metal probe pushing them all, pretty small but you know, if I set up a guide and push the probe through the guide, it will go to the geometric, 3D place where the thing is programmed. But if I push the thing with my hand, I have experience in hand. I know what the brain feels like when you do that. And when I ran into something hard or soft, that’s information I want. You might program a robot to do that, but I am not sure if it exists. My hand is going to be more accurate and why would you brother?

So you would need some kind of advanced force feed back?

It works for that.

Thank you.