The brain cannot be cut open like other organs. A small difference of just 5㎜ can lead to memory loss or damage to language, motor, or visual functions. The introduction of robotic systems in brain surgery, where results can vary due to minor errors, has brought about significant changes.
The brain surgery robot 'Geniant Cranial' developed by KOREA's Kohyoung Technology will embark on its first export to the United States next month. Yonsei University's Severance Hospital was the first to introduce this robot in the medical field. Professor Jang Won-seok from Severance Hospital's Department of Neurosurgery noted on the 17th, 'Neurosurgeons with Kohyoung robots will no longer need to use existing stereotactic frames.'
Geniant Cranial is a robotic system that guides doctors to accurately insert electrodes and biopsy devices into the brain. Previously, surgeries were performed with the patient's head fixed in a stereotactic frame. Geniant is an upgraded product of the brain surgery robot 'KYMERO' released by Kohyoung Technology in 2020, which received domestic approval in December of last year and FDA approval in January of this year.
◇Navigation robot for locating brain surgery sites
Kohyoung is the world's No. 1 company in semiconductor 3D solder paste inspection equipment. The company began developing medical robots in collaboration with Hanyang University as part of a national project by the Ministry of Trade, Industry and Energy in 2011. Kohyoung believed that its 3D measurement technology accumulated in the semiconductor inspection equipment field could dramatically increase the precision of brain surgeries. The fruits of that labor are KYMERO and Geniant Cranial.
Geniant is a robot that assists in stereotactic neurosurgery. This surgery is a method that accurately identifies and removes or blocks areas causing brain diseases such as brain tumors, epilepsy, and Parkinson's disease. This includes deep brain stimulation (DBS), which involves inserting electrodes into the brain of Parkinson's patients to treat symptoms like muscle tremors, and stereoelectroencephalography (SEEG), which involves inserting microelectrodes to measure brain waves to find the cause of epileptic seizures.
Professor Jang said, 'Before the robotic system was introduced, we used stereotactic frames for surgeries.' The frame, which looks like a large protractor, is fixed to the patient's head with screws. After calculating the coordinates of the lesion's location in x, y, z axes using brain imaging, the doctor targets to insert electrodes or instruments. However, it was limited in that it could not account for minor errors that are difficult to distinguish with the naked eye, and variations occurred depending on the surgeon's skill.
Geniant Cranial consists of optical sensor markers and a guide robot attached to the operating table, along with a navigation platform that shows the surgery area and path. Like a car navigation system, it precisely detects and tracks the position and movements of the patient and surgical tools in real time. The robotic equipment has overcome the limitations of conventional stereotactic surgeries.
◇Reduced side effects and pain through precision surgery
Professor Jang introduced the case of a child with epilepsy whose seizure symptoms occurred several times a day, making school life impossible. About 30% of epilepsy patients require surgery because drug treatment is ineffective. The patient at that time also needed surgery, but since the area to be resected was near the hippocampus, which is responsible for memory, there was a risk of memory damage.
Professor Jang noted, 'Through the brain surgery robot, we inserted more than 10 stereoelectrodes with a thickness of 0.8㎜ in several places and precisely analyzed the area where seizures began. Thanks to this, we were able to remove only the surrounding lesion without damaging the hippocampus, allowing the child to escape from seizures while fully retaining memory.'
The epilepsy surgery starts by accurately locating the brain area that induces seizures. This is precisely the purpose of the stereoelectrode insertion procedure, which measures the electrical signals deep in the brain using inserted electrodes. Although this procedure is merely for creating a brain map, side effects such as bleeding, headaches, and vomiting were common. There were also cases where emergency reoperations were needed due to brain hemorrhaging post-surgery.
With the introduction of robots, such surgeries have become much easier. Patient recoveries have also noticeably changed. Professor Jang said, 'A young patient who underwent robotic surgery was playing with a tablet PC the next day,' adding, 'Most importantly, the biggest change is that the patient has become more comfortable, which is the advantage of robotic surgery.'
The brain surgery robot is also used for biopsies to extract tumor tissue. If a tumor is large, it requires tissue extraction from multiple sites. Using the existing stereotactic frame means that coordinates must be recalculated for each area, which takes a significant amount of time. Professor Jang explained, 'Just by clicking the location on the screen, the robot autonomously guides us there, making it convenient for medical personnel and reducing the time spent.'
◇Doctors and engineers collaborate to develop brain surgery robots
Kohyoung's first brain surgery robot, KYMERO, has been introduced to several hospitals in Korea, including Severance Hospital, since 2020. The number of surgeries performed using KYMERO surpassed 600 last month. Severance Hospital began using the successor product, Geniant Cranial, this month.
Previously, specialists from organizations such as Harvard Medical School and Severance Hospital participated in Kohyoung's brain surgery robot research and development. Notably, Professor Jang Jin-woo of the Department of Neurosurgery actively provided feedback on the necessary robotic technologies and functions from the medical personnel's perspective.
Professor Jang Jin-woo is a leading authority in the field of stereotactic functional neurosurgery, which treats functional abnormalities in the nervous system such as the brain and spinal cord. He retired from Severance Hospital in February of last year and moved to Korea University Anam Hospital.
Although the medical device market is dominated by large global corporations, there is currently no leading company in brain surgery robots. Professor Jang Won-seok stated, 'This is also due to the fact that global medical robot companies prioritize laparoscopic surgery or artificial joints and spinal surgery. If Kohyoung's brain surgery robot rapidly gains competitiveness, I believe it can secure an advantage in the global market.'