NaoTrac: Transforming Brain Surgery with SMART Technology

SMART Technology, or Surface Mapping Auto-registration Technology, is Brain Navi’s core technology. It combines machine vision, a robotic arm, and an in-house-designed algorithm to achieve “real-time” imaging, “precise surgery,” and “minimally invasive outcomes.” This Technology gives NaoTrac the precision to navigate autonomously to the target, making it a unique surgical navigation robot. In this interview with Dr. Jerry Chen, the CEO of Brain Navi Biotechnology, we will learn how their unique process improves surgical navigation and saves lives beyond some guidelines in neurosurgery.

Q1: What is SMART Technology? How is it different from the current technology?

The most significant difference compared to current technology is the flexibility during surgery. Let’s take some properties of NaoTrac as an example:

  1. Surgical Tool Registration: Normally, traditional navigation systems require their own developed tools making it unflexible, and their measurements have to be inputted in advance, but this is not always fit the standard practice. With surgical tool registration, NaoTrac can recognize standard surgical tools that the surgeons have already practiced with for a long time. The team designed instrument holders of different sizes to fit the dimensions of surgical tools.
  2. Patient Registration: NaoTrac registers the patient’s physical anatomical landmarks with more than 100,000 checkpoints, increasing registration accuracy to less than 0.5mm, and enhancing the precision of surgery. The combination of AI technology and machine vision facilitates the facial recognition processes more intuitively and can meet any position required for surgery, even the prone position, as demonstrated at Hualien Tzu-Chi Medical Center with stem-cell implantation.
  3. Non-contact moving defection: If the surgical bed moves incidentally, NaoTrac can recalibrate to the correct location. If the distance is greater than the detection area, the monitor will show an emergency signal and stop any movement immediately.

Q: What clinical needs does SMART Technology fulfill?

Precision is the primary and essential requirement for brain surgery; however, daily practice requires more than precision. Faster registration and delicate movement are saving time and lives. With the assistance of robotic arm technology, the surgical pathway can be accurate and move slowly and steadily. Some current solutions in the market are slow in patient registration and have no instrument registration at all, leading to many challenges in the operating room due to space constraints and the need for repositioning during surgery, which increases the risk of surgery. SMART Technology was developed to fulfill these clinical needs in the operating room. The mission of SMART Technology is to improve surgical accuracy, streamline the surgical procedure, and shorten the learning curve.

Q: What inspired the use of machine vision in the medical field, especially given the high precision required in brain surgery?

AI technology with machine vision has a long history of use in industries and is a mature and stable technology. It serves as the “eye” of robots and has been used in automotive assembly, Cultural Relics Preservation, and car driving assistants like Tesla. We have started to use this technology for more than 7 years and have become the leader in using machine vision in the surgical robotic area. 

Q: How does AI Technology take place in SMART Technology?

AI technology focuses on stereotaxic positioning, using AI technology to detect facial landmarks, fusion medical images, and automatically map all the information, reducing the time of manual registration and increasing the accuracy of patient registration.

Unlike traditional pathway planning methods, AI technology saves a lot of calculation time and improves the quality of planning processes. It provides specific information on surgical pathways, assists in planning surgical paths, and analyzes the risk and safety of various designed pathways. In the future, it can avoid essential blood vessels and provide information on the impact area and brain function on the surgical pathway, as well as show multiple levels of tractography, cortical functional areas, and vessels. The combination of the robotic arm, machine vision, and AI Technology can provide precise positioning, multi-modal imaging system information, and AI technology assistance systems to assist surgeons more efficiently and intuitively.

“To register patients automatically and proceed with robotic-assisted surgery is an unstoppable trend and should extend the technology of the medical industry in this direction,” says Dr. Guo Jeng-Hong, a neurosurgeon from China Medical University Hospital.

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Q: What kind of brain surgical application can NaoTrac do now? Any special case you would like to share?

It’s impressive to see the various applications of NaoTrac and how it can assist in different types of brain surgeries. NaoTrac is now playing the role of “Enabler”. The ability to register the patient in a prone position and perform stem-cell implantation is a great demonstration of the technology’s flexibility. It’s also encouraging to see how NaoTrac has been used in the treatment of ICH (intracranial hemorrhage). Usually, when the blood clot is less than 30ml, the mortality rate is low and conservative treatment is usually the choice. However, low mortality does not indicate low morbidity, the functional loss is always the hurdle for the patient and family. For example, in a 48-year-old male who suffered from left putamen hemorrhage early this year, the muscle power of the right upper and lower limb still remains zero after 5 days. We aspirated the blood clot on day 5 and the muscle power recovered to 1 in 24 hours and to 3 in 96 hours. The improvement is so evident that it changed his and his family’s life for good. Early intervention with NaoTrac to treat ICH shows great functional recovery and encourages doctors to help more people as well in a biopsy, endoscopic surgery, EVD, Stereo EEG, and DBS. 

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