University of São Paulo: Robot should help doctors in surgeries with children suffering from epileptic seizures

PResearchers at the São Carlos School of Engineering (EESC) at USP are developing a robot to be used during surgeries performed on children suffering from epilepsy, one of the most frequent neurological problems in childhood. In most cases, the seizure is treated with medication, but about 25% of patients do not respond to clinical treatment. The new machine will help doctors to insert electrodes into the skull of those who have this health problem so that the brain can be monitored during a crisis, providing accurate data to professionals. With technology, the operation will become much safer, faster and more efficient than those performed today in hospitals.

“The robot has cameras and distance sensors. An artificial intelligence system analyzes the images, the captured data and maps the points to insert the electrodes. The doctor will have a guide. There’s no mistake. It is more safe for children who undergo this type of procedure ”, points out Glauco Caurin


The new “robot-neurosurgeon” is being built and tested inside one of the hangars of the EESC’s Department of Aeronautical Engineering (SAA). Glauco Caurin, professor at the school and project coordinator, explains that the equipment, generally used in the manufacture of airplanes, is now being adapted to assist health professionals. In practice, based on 3D images of the patient’s brain received online, the machine will assist healthcare professionals to interpret them and calculate exactly where the electrodes should be inserted, placing a tubular tool on the child’s head to the medical team to place the sensors. A collaborative way of working between the robot and the surgeon.

“The robot has cameras and distance sensors. An artificial intelligence system analyzes the images, the captured data and maps the points to insert the electrodes. The doctor will have a guide. There’s no mistake. It is more safe for children who undergo this type of procedure ”, celebrates the engineer.

With the robot, the surgical procedure will also be much faster. Nowadays, the tasks performed during the operation are mostly performed manually by doctors, who have only limited computer programs to assist them.

Professor Hélio Machado, from the Department of Surgery and Anatomy of the Ribeirão Preto School of Medicine (FMRP) at USP, a partner institution in the study, explains that brain injuries that occurred early, even during the formation of the organ, are among the main causes of seizures in children. “These injuries lead to the malfunction of part of the brain, which becomes a generator of seizures. In such cases, it is necessary to find the exact place where the crisis begins and where it spreads. Currently, the best way to study each case is by inserting 5 to 15 electrodes into the patient’s skull, which are connected to a monitoring system ”, he explains.


After the electrode placement procedure, the patient is under observation at the Hospital das Clínicas of the FMRP for up to one week. The goal is to wait for the child to have a crisis so that, from the electrical signals emitted by the sensors, doctors are able to identify the origin of the seizure and plan more accurately the removal of the diseased region of the brain.

To create the new technology, the researchers imported a state-of-the-art articulated mechanical arm of approximately 1.6 meters (m) and 45 kilos (kg) from Germany, which will be controlled by computational codes that are being developed at EESC. “We are applying neurosurgery systems created for different areas and adapting software already available on the market, some developed by Brazilian universities, to make the cost of production cheaper and, consequently, the innovation more accessible to hospitals”, explains the professor at EESC .

As there are several stages in this type of surgery, the proposal is that, in the future, the robot be programmed to perform different actions during the procedure. The equipment has a slot on the tip so that several instruments can be coupled and, during the operation, the doctor will be able to change the tools according to the task he wants to perform. “He shows a QR Code for the robot to identify which utensil he is receiving at that moment. At each step forward, the doctor presses command buttons. It is very simple, but professionals will need training, ”ponders Caurin.

The partnership between EESC and FMRP started in 2014, when Professor Hélio Machado got in touch with Glauco after returning from a business trip, where he was with the head of Pediatric Neurosurgery at the Rothschild Foundation Hospital, in Paris, France, who also was dedicated to epilepsy surgeries in childhood and was a pioneer in the use of robots in 2009. During the visit, Machado had the opportunity to visit the factory of the company that produced the first neurosurgical robot in the world and returned excitedly to Brazil with the possibility to develop something around here.

“Working with groups from other areas of knowledge allows a spectacular technological advance for our country, avoiding the import of equipment that is sometimes extremely expensive. Robotic surgery in our environment has all the conditions to be very successful, bringing invaluable benefits to our small patients ”, celebrates Hélio Machado.


“I was very interested. I didn’t know Professor Glauco personally, but I had already seen presentations by some of his students at student congresses on robotic arms. I contacted him and, in 2016, we held the first workshop on robotic surgery in São Carlos. That was when things really started to develop ”, recalls Machado. Currently, the teams work very closely, despite the isolation imposed by the covid-19 pandemic. “We want to identify what the challenges are and how we can help to solve these difficulties”, says Glauco Caurin.

At least half of the more than two thousand children attended by the Hospital das Clínicas (HC) of the FMRP, in Ribeirão Preto, where there is a sector dedicated exclusively to the approach of epilepsy, can benefit from the new assistant robot.

“Working with groups from other areas of knowledge allows a spectacular technological advance for our country, avoiding the import of equipment that is sometimes extremely expensive. Robotic surgery in our environment has all the conditions to be very successful, bringing invaluable benefits to our small patients ”, celebrates Hélio Machado.

Since the 1980s, technology has advanced a lot in the area and providing the production of robots that can collaborate with medicine. There are still no 100% autonomous machines for operating patients, nor is this the objective of the researchers from São Carlos.

“We want to optimize some of the precious skills of humans to make these professionals less tired. The robot is an assistant who will not take the profession of the nurse, the nursing technician or the scrub nurse, let alone the doctors, ”says Caurin.

The technology under development at EESC has been tested through simulations on artificial skulls, aiming to identify possible system errors and to predict all problems that may arise at the time of surgery. According to the EESC professor, the robot’s safety needs to be strict, as the machine will handle lives. “From an engineering point of view, the control techniques that we use are the best currently available on the planet. Before the completion of exhaustive tests, the robot will not be taken to hospitals ”, guarantees the study coordinator. Experts hope that, in the second half of this year, it will be possible to start a phase of testing with patients.

The first results of the research are already being compiled and prepared for publication in international scientific journals. Studies on robotic surgery in Brazil, however, are still very recent. “We are starting to develop this area in the country and we are excited, but there is still a long way to go”, explains Caurin. The research, which was funded by the São Paulo State Research Support Foundation (Fapesp) and by the Studies and Projects Financing Agency (Finep), involves undergraduate, master’s and doctoral students from USP. In the future, scientists intend to create systems that interpret data captured by the electrodes and implant technologies in the equipment so that it recognizes gestures and works with Augmented Reality.

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