Hello, my name is Robert Sickler, I'm a second year medical student at McGovern Medical School at UT Health in Houston, Texas, and I'm here to present our comparison of ROSA and the self-autoguide robot-assisted SAG implantations. There's no relevant financial disclosures for this presentation, and our research was made possible by Children's Memorial Hermann Hospital in Houston, Texas. Refractory pediatric epilepsy affects about 1 in 900 children, and in these patients, surgical intervention presents an effective and evidence-based alternative to continued medical management. When Phase I non-invasive techniques lead to multiple seizure-focused hypotheses, Phase II invasive monitoring is required with either subdural electrodes or stereoencephalography to guide Phase III resection or ablation. Recently, various robot-assisted techniques, including the ROSA and self-autoguide systems, have been adopted in hopes of increasing the efficiency and safety of SAG implantation. Crucially, however, to date, no investigation has been conducted directly comparing the safety and accuracy of these two systems within a single institution. ROSA specifically has been shown to decrease operative times without any decrease in safety or precision, and I included these images so you can see the overall scale of this robot. Especially on the image on the right, you guys can probably see that it's a very large, very rigid structure. Self-autoguide in comparison is a much smaller, miniature robotic arm. You can see in the bottom right image, the actual robot is on the right of the patient's head with a controller on the left. In comparison to ROSA, it's much smaller, much less rigid, but it, too, has been shown to yield high procedure accuracy without increased off-time or any application-related adverse effects. We reviewed 22 sequential pediatric SAG implantations over the last four years at our hospital, consisting of 15 ROSA-guided procedures and 7 autoguide-guided procedures. We determined the mean operative time, mean time per electrode, registration room-mean square error, and surgical qualifications for each robot, and we also reviewed 7 additional autoguide-guided procedures for any complications as well. Looking at the demographics of our two patients, we found no difference between age, gender, mean number of electrodes placed per patient, and the number of patients that proceeded to face a resection or ablation between our two robot groups. Looking at our direct comparison of the two robots, we found no difference in mean registration and RMS. However, we found increased mean operative time and mean time per electrode for autoguide procedures, which came in at around about twice as long each. We found no complications for either robot, including the 7 additional autoguide procedures. Our results thus showed that autoguide patients were demographically similar to ROSA patients, and that both robots were highly accurate with no significant registration and RMS differences. Neither resulted in any complications, such as infection or hemorrhage, the two most frequent for SAG implantation. However, both overall op time and time per electrode were found to be significantly greater for autoguide procedures. Overall sources for error include arm rigidity, with ROSA being more rigid, human measurement error for target, which should be comparable, and registration error, which is shown here to be comparable. Additional factors for consideration include cost, with stealth autoguide costing about a quarter of that of the ROSA robot, the fact that the registration for autoguide is very simple for any neurosurgeons who have used a stealth system before, and the fact that we expect autoguide op times to decrease as our experience with the system grows. All in all, we found both robots to be very safe and function appropriately in their diagnostic capacity for guiding phase 3 surgeries. Continued comparisons, including analysis of the Euclidean distance between actual and planned trajectories, including at both entry and target points, will further aid in determining the advantage to each of these systems. I'd like to end by thanking my mentor, Dr. Manish Shah, and all my co-authors, as well as Children's Memorial Hermann Hospital, for making this presentation possible. Thank you very much.

ROSA

self-autoguide

SAG implantations

operative times

procedure accuracy