title: Robotic digital subtraction angiography systems within the hybrid operating room.
abstract: BACKGROUND
  Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery.
  
  
  OBJECTIVE
  To describe initial clinical experience with a robotic DSA system in the hybrid OR.
  
  
  METHODS
  A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR. The system consists of a multiaxis robotic C arm and surgical OR table. In addition to conventional neuroendovascular procedures, the system was used as an intraoperative imaging tool for various neurosurgical procedures such as aneurysm clipping and spine instrumentation.
  
  
  RESULTS
  Five hundred one neurosurgical procedures were successfully conducted in the hybrid OR with the robotic DSA. During surgical procedures such as aneurysm clipping and arteriovenous fistula treatment, intraoperative 2-/3-dimensional angiography and C-arm-based computed tomographic images (DynaCT) were easily performed without moving the OR table. Newly developed virtual navigation software (syngo iGuide; Siemens AG) can be used in frameless navigation and in access to deep-seated intracranial lesions or needle placement.
  
  
  CONCLUSIONS
  This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.
authors.affiliation: Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan. ymurayama@jikei.ac.jp
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Koreaki
authors.initials: K
authors.lastname: Irie
authors.forename: Takayuki
authors.initials: T
authors.lastname: Saguchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ishibashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Ebara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Nagashima
authors.forename: Akira
authors.initials: A
authors.lastname: Isoshima
authors.forename: Hideki
authors.initials: H
authors.lastname: Arakawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takao
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohashi
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Joki
authors.forename: Masataka
authors.initials: M
authors.lastname: Kato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tani
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikeuchi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Abe
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods* / Q000639:trends; D009873:Operating Rooms / Q000379:methods* / Q000639:trends; D012371:Robotics / Q000379:methods* / Q000639:trends