Operation video recording is one of efficient methods for analyzing surgical workflow and intraoperative incident detection. In “Intelligent Operating Room” at Tokyo Women's Medical University Hospital, the special neurological surgery called awake craniotomy is recorded by video recording system IEMAS (Intraoperative Examination Monitor for Awake Surgery). There are a number of useful video records of surgical procedure such as patient reactions and surgical operations. However, these surgical event tags which are used for surgcial workflow analysis are not contained in IEMAS records. IEMAS is composed multi-view video cameras, so manual tagging for video records is a lot of labor because of the large length of surgical operation videos. In awake craniotomy, electrical stimulation is one of significant surgical operations for detecting eloquent brain areas. In this paper, we propose the automatic detection method for the stimulation points onto patient's brain areas from raw IEMAS video records by using image processing approach. In the previous work, we proposed stimulation timing detection method from surgery sound records of IEMAS. Hence, we propose a detection method of surgical instrument for electrical stimulation in order to tag the stimulated positions on surgical view. However, detected positions on the video frame coordinates depend on camera view changes. Therefore, we map video frame positions to representative video frame positions by using homography transformation in order to enable to analyze stimulated points relation. We applied automatic video tagging method for several raw IEMAS video records and show its performance.

We have developed an laser ablation system with an automatic focusing (AF) and robotic scanning mechanism for precision malignant gliomas resection in neurosurgery. A 5-aminolevulinic acid (5-ALA)-induced fluorescence based intra-operative tumor diagnosis technique has been incorporated into the robotic laser ablation system. The system enables an intra-operative identification of the position of a tumor with fluorescence illuminated by a laser excitation. The AF and robotic scanning mechanism assists in tracking the surface of the malignant brain tumors, and provides position information for both laser scanning in 5-ALA fluorescence identification and laser ablation in tumor resection. Experimental results showed the automatic focus device had a precision of 0.5 mm and the mechanism could track the brain surface with a movement caused by pulsation and respiration.

In recent years there has been an ever increasing amount of research and development of technologies and methods to improve the quality and the performance of advanced surgery. In other fields several training methods and metrics have been proposed, both to improve the surgeon's abilities and also to assess her/his skills. For neurosurgery, however, the extremely small movements and sizes involved have prevented until now the development of similar methodologies and systems. In this paper we present the development of an ultra-miniaturized Inertial Measurement Unit and its application for the evaluation of the performance in a simple pick and place scenario. This analysis is a preliminary yet fundamental step to realize a better training/evaluation system for neurosurgeons, and to objectively evaluate and understand how the neurosurgery is performed.

Minimally invasive surgery has recently become a key word in medical engineering. In this operation, to introduce surgical instruments, spatulas which push tissues aside and retain the approach path to the affected area as well as workspace for the insertion of such instruments are necessary. Therefore, a new type of hydraulically-driven flexible manipulator for neurosurgery has been developed. With an attached balloon and using only physiological saline for the drive system, safety of the brain tissue, especially in terms of pressure, is assured as is the simplicity of the mechanism. In addition, this provides the advantage of MRI compatibility. From the results of several evaluations, this manipulator has been proved effective as a new type of medical device.

We performed 148 open magnetic resonance imaging (MRI) surgeries at Tokyo Women's Medical University between March 3, 2000 and December 13, 2002. Especially for malignant brain tumors located in or adjacent to the functional region, we have tried to improve resection rate and to preserve critical brain function by means of not only intraoperative MRI but also concomitant application of various technique including awake surgery, real-time update navigation, chemical navigation, intraoperative soft X-ray irradiation, etc. In our 46 malignant glioma cases an average resection rate achieved 91% as revealed using pre- and post-operative MR images. A total removal rate was 39% compared to 8% of statistics of the brain tumor registry of Japan 1981 to 1992. Here we describe a newly innovated neurosurgical system with special reference to the augmented reality including information-guided navigation system (high definition visual computer-aided surgery system: HivisCAS), and computer-aided design and computer-aided manipulation (CAD-CAM) surgery.