Introduction. Robotics in neurosurgery

T he past 2 decades have seen the rapid development and commercialization of numerous robotic systems in surgery.In terms of growth and adoption, the laparoscopic/thoracoscopic platforms such as the da Vinci Surgical System have experienced the greatest increases, and in 2015 over 700,000 surgical procedures were performed using this system.Growth in this area continues, and it has been projected that use of the robot for procedures such as a minimally invasive colectomy will increase over the next 10 years by 38%. 3 Numerous other competitive platforms are also being developed due to this early success.This includes joint ventures such a recent collaboration between Google/Alphabet and Johnson & Johnson that plan to leverage machine learning and perhaps iterate on the "slave" role of robots.Interestingly, to date neurosurgery has not seen as broad an adoption of robotic techniques.However, the field of neurological surgery is well suited for the incorporation of robotic assistance. 2 Traditionally, several aspects of our subspecialty lend themselves to the need and implementation of robotics, including the following: 1) the rich history of neurosurgical innovation in stereotaxy and navigated localization; 2) the tight anatomical confines that are armored by and oriented very specifically to bony structures; 3) the microsurgical nature of our procedures; 4) the highly technical nature of the field; 5) the growth and need for growth in minimally invasive neurosurgery; and 6) a culture that adopts and embraces new technology with optimism.Indeed, the development of the CyberKnife by John Adler, a neurosurgeon at Stanford University, represented perhaps the first true modern application of robotic surgery. 1 The CyberKnife was the first platform that allowed for the entire procedure to be executed without direct surgeon-patient contact and with full control from a remote location.As such, it represented the actualization of robotic neurosurgery.Thus, perhaps the reason why robotic neurosurgery has been slow to develop has not been for lack of creativity, vision, desire, or capitalization but, rather, because of the