Dr. Ramesh Doddamani Podcast

This video illustrates the robot-guided ventriculoperitoneal (VP) shunt procedure in slit-like ventricles, a technique used for patients with small cerebral ventricles where conventional freehand access can be difficult or inaccurate.

Ventriculoperitoneal shunts are commonly used to treat hydrocephalus by diverting excess cerebrospinal fluid (CSF) from the brain’s ventricles into the peritoneal cavity, relieving intracranial pressure. In patients with slit-like or very small ventricles, standard freehand shunt placement is often challenging and associated with high failure rates because the ventricle is hard to cannulate accurately.

This video shows how robotic guidance with a stereotactic system (e.g., ROSA robot) improves the precision of ventricular catheter placement:

• Preoperative CT imaging is uploaded into the robotic software for 3D trajectory planning.
• The patient is positioned and registered with the robotic system using laser facial scanning.
• The robotic arm navigates the preplanned trajectory, allowing the ventricular catheter to be inserted into the small ventricle on the first attempt.
• The distal catheter and valve are connected and tunneled in the standard fashion.

In published case series, robot-guided shunt placement enabled accurate ventricular entry on the first attempt in all patients with slit-like ventricles, including those with idiopathic intracranial hypertension (IIH) and persistent CSF leaks. Postoperatively, patients experienced symptom relief such as reduced headaches and improved vision, demonstrating the effectiveness and safety of the robotic technique.

Robotic guidance provides a stable, precise method for CSF diversion, especially in patients where small ventricles make freehand placement technically difficult. It enhances surgical accuracy and may reduce complications relating to catheter positioning.