1
|
Gottsauner M, Morawska MM, Tempel S, Müller-Gerbl M, Dalcanale F, de Wild M, Ettl T. Geometric Cuts by an Autonomous Laser Osteotome Increase Stability in Mandibular Reconstruction With Free Fibula Grafts: A Cadaver Study. J Oral Maxillofac Surg 2024; 82:235-245. [PMID: 37980939 DOI: 10.1016/j.joms.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Nonunion and plate exposure represent a major complication after mandibular reconstruction with free fibula flaps. These drawbacks may be resolved by geometric osteotomies increasing intersegmental bone contact area and stability. PURPOSE The aim of this study was to compare intersegmental bone contact and stability of geometric osteotomies to straight osteotomies in mandibular reconstructions with free fibula grafts performed by robot-guided erbium-doped yttrium aluminum garnet laser osteotomy. STUDY DESIGN, SETTING, SAMPLE This cadaveric in-vitro study was performed on fresh frozen human skull and fibula specimens. Computed tomography (CT) scans of all specimens were performed for virtual planning of mandibular resections and three-segment fibula reconstructions. The virtual planning was implemented in a Cold Ablation Robot-guided Laser Osteotome. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE For predictor variables, straight and geometric puzzle-shaped osteotomies were designed at resection of the mandible and corresponding fibula reconstruction. MAIN OUTCOME VARIABLES The primary outcome variable was the stability of the reconstructed mandible investigated by shearing tests. Moreover, secondary outcome variables were the duration of the laser osteotomies, the contact surface area, and the accuracy of the reconstruction, both evaluated on postsurgical CT scans. COVARIATES Covariables were not applicable. ANALYSES Data were reported as mean values (± standard deviation) and were statistically analyzed using an independent-sample t-test at a significance level of α = 0.05. Root mean square deviation was tested for accuracy. RESULTS Eight skulls and 16 fibula specimens were used for the study. One hundred twelve successful laser osteotomies (96 straight and 16 geometrical) could be performed. Geometric osteotomies increased stability (110.2 ± 36.2 N vs 37.9 ± 20.1 N, P < .001) compared to straight osteotomies. Geometric osteotomy of the fibula took longer than straight osteotomies (10.9 ± 5.1 min vs 5.9 ± 2.2 min, P = .028) but could provide larger contact surface (431.2 ± 148.5 mm2 vs 226.1 ± 50.8 mm2, P = .04). Heat map analysis revealed a mean deviation between preoperational planning and postreconstructive CT scan of -0.8 ± 2.4 mm and a root mean square deviation of 2.51 mm. CONCLUSION AND RELEVANCE Mandibular resection and reconstruction by fibula grafts can be accurately performed by a Cold Ablation Robot-guided Laser Osteotome without need for cutting guides. Osteotomy planning with geometric cuts offers higher stability and an increased bone contact area, which may enhance healing of the reconstructed mandible.
Collapse
Affiliation(s)
- Maximilian Gottsauner
- Coordinator of the Head and Neck-Tumor-Center, Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Marta M Morawska
- Clinical Affairs Manager, Advanced Osteotomy Tools (AOT AG), Basel, Switzerland
| | - Simon Tempel
- Project Manager for Research & Development, Advanced Osteotomy Tools (AOT AG), Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Director of the Department of Anatomy, Department of Anatomy, University of Basel, Basel, Switzerland
| | - Federico Dalcanale
- Scientist, Fachhochschule Nordwestschweiz, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - Michael de Wild
- Head of the Division, Fachhochschule Nordwestschweiz, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - Tobias Ettl
- Deputy Director, Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
2
|
Hamidi A, Bayhaqi YA, Drusová S, Navarini AA, Cattin PC, Canbaz F, Zam A. Multimodal feedback systems for smart laser osteotomy: Depth control and tissue differentiation. Lasers Surg Med 2023; 55:900-911. [PMID: 37870158 DOI: 10.1002/lsm.23732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The study aimed to improve the safety and accuracy of laser osteotomy (bone surgery) by integrating optical feedback systems with an Er:YAG laser. Optical feedback consists of a real-time visual feedback system that monitors and controls the depth of laser-induced cuts and a tissue sensor differentiating tissue types based on their chemical composition. The developed multimodal feedback systems demonstrated the potential to enhance the safety and accuracy of laser surgery. MATERIALS AND METHODS The proposed method utilizes a laser-induced breakdown spectroscopy (LIBS) system and long-range Bessel-like beam optical coherence tomography (OCT) for tissue-specific laser surgery. The LIBS system detects tissue types by analyzing the plasma generated on the tissue by a nanosecond Nd:YAG laser, while OCT provides real-time monitoring and control of the laser-induced cut depth. The OCT system operates at a wavelength of 1288 ± 30 nm and has an A-scan rate of 104.17 kHz, enabling accurate depth control. Optical shutters are used to facilitate the integration of these multimodal feedback systems. RESULTS The proposed system was tested on five specimens of pig femur bone to evaluate its functionality. Tissue differentiation and visual depth feedback were used to achieve high precision both on the surface and in-depth. The results showed successful real-time tissue differentiation and visualization without any visible thermal damage or carbonization. The accuracy of the tissue differentiation was evaluated, with a mean absolute error of 330.4 μm and a standard deviation of ±248.9 μm, indicating that bone ablation was typically stopped before reaching the bone marrow. The depth control of the laser cut had a mean accuracy of 65.9 μm with a standard deviation of ±45 μm, demonstrating the system's ability to achieve the pre-planned cutting depth. CONCLUSION The integrated approach of combining an ablative laser, visual feedback (OCT), and tissue sensor (LIBS) has significant potential for enhancing minimally invasive surgery and warrants further investigation and development.
Collapse
Affiliation(s)
- Arsham Hamidi
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Yakub A Bayhaqi
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Sandra Drusová
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Alexander A Navarini
- Digital Dermatology, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Center for medical Image Analysis and Navigation (CIAN), University of Basel, Allschwil, Switzerland
| | - Ferda Canbaz
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Azhar Zam
- Biomedical Laser and Optics Group (BLOG), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Division of Engineering, New York University Abu Dhabi, Abu Dhabi, UAE
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, USA
| |
Collapse
|
3
|
Wojcik T, Morawska M, Ferri J, Müller-Gerbl M, Nicot R. Robotic calvarial bone sampling. J Craniomaxillofac Surg 2023; 51:603-608. [PMID: 37806905 DOI: 10.1016/j.jcms.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
The aim of this study was to assess the feasibility of complex unicortical calvarial harvesting by using the Cold Ablation Robot-Guided Laser Osteotome (CARLO® primo+). A cadaveric study was performed with a progressive complexity of the bone harvesting. This preliminary study on the cadaveric cranial vault area examined the tracking precision, the strategies, settings and durations of harvesting, the accuracy of the unicortical bone cutting, and the risk of dura exposition. All sampling was realised with no more difficulty than that experienced during the standard procedure. No bicortical cutting occurred during CARLO® primo + robot-guided laser cutting. During the second sampling, dura was partially exposed due to improper angulation of the curved osteotome during harvesting. Complex unicortical calvarial harvesting using robot-guided laser appears to be feasible and safe. In the future, robotic approaches will probably replace current surgical techniques using cutting guides and help reduce intraoperative inaccuracies due to the human factor.
Collapse
Affiliation(s)
- Thomas Wojcik
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France.
| | | | - Joël Ferri
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France.
| | | | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillo-Facial Surgery Department, U1008 - Advanced Drug Delivery Systems, F-59000, Lille, France; Univ. Lille, Centrale Lille, CNRS, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France.
| |
Collapse
|
4
|
Xiao L, Guo J, Wang H, He Q, Xu Y, Yuan L, Yi Q, Zhang Q, Wang J, Min S, Zhao M, Xin X, Chen H. Thermal damage and the prognostic evaluation of laser ablation of bone tissue-a review. Lasers Med Sci 2023; 38:205. [PMID: 37676517 DOI: 10.1007/s10103-023-03868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
In recent years, an increasing number of scientists have focused on conducting experiments on laser ablation of bone tissue. The purpose of this study was to summarize the prognosis of tissue and the extent of thermal damage in past hard tissue ablation experiments, and review the evidence for the feasibility of laser osteotomy in surgery. An electronic search of PubMed, China National Knowledge Infrastructure (CNKI), and Web of Science (WOS) for relevant English-language articles published through June 2023 was conducted. This review includes 48 literature reports on laser ablation of hard tissues from medical and biological perspectives. It summarizes previous studies in which the ideal ablation rate, depth of ablation, and minimal damage to bone tissue and surrounding soft tissues were achieved by changing the laser type, optimizing the laser parameter settings, or adding adjuvant devices. By observing their post-operative healing and inflammatory response, this review aims to provide a better understanding of pulsed laser ablation of hard tissues. Previous studies suggest that laser osteotomy has yielded encouraging results in bone resection procedures. We believe that low or even no thermal damage can be achieved by experimentally selecting a suitable laser type, optimizing laser parameters such as pulse duration and frequency, or adding additional auxiliary cooling devices. However, the lack of clinical studies makes it difficult to conclusively determine whether laser osteotomy is superior in clinical applications.
Collapse
Affiliation(s)
- Liuyi Xiao
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Junli Guo
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu, 610209, China
- Key Laboratory of Optical Engineering, Chinese Academy of Sciences, Chengdu, 610209, China
| | - Huan Wang
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Qianxiong He
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Yang Xu
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Lu Yuan
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Qianya Yi
- Ophthalmology Department, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Qian Zhang
- West China Forth University Hospital Ophthalmology Department, Chengdu, 610044, China
| | - Jin Wang
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu, 610209, China
- Key Laboratory of Optical Engineering, Chinese Academy of Sciences, Chengdu, 610209, China
| | - Shaokun Min
- Qianjiang Xinhua Middle School, Chongqing, 404100, China
| | - Menghan Zhao
- Pujiang County People's Hospital, Chengdu, 611630, China
| | - Xiaorong Xin
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| | - Hui Chen
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200080, China.
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, 200080, China.
- National Clinical Research Center for Eye Diseases, Shanghai, 200080, China.
- University of Shanghai for Science and Technology, Shanghai, 200093, China.
- Chengdu Medical College, Chengdu, 610083, China.
- Key Laboratory of Sichuan Province Ophthalmopathy Prevention & Cure and Visual Function Protection, Chengdu, 610209, China.
| |
Collapse
|
5
|
Wu J, Hui W, Huang J, Luan N, Lin Y, Zhang Y, Zhang S. The Feasibility of Robot-Assisted Chin Osteotomy on Skull Models: Comparison with Surgical Guides Technique. J Clin Med 2022; 11:jcm11226807. [PMID: 36431284 PMCID: PMC9696640 DOI: 10.3390/jcm11226807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Surgical robotic technology is characterized by its high accuracy, good stability, and repeatability. The accuracy of mandibular osteotomy is important in tumor resection, function reconstruction, and abnormality correction. This study is designed to compare the operative accuracy between robot-assisted osteotomy and surgical guide technique in the skull model trials which simulated the genioplasty. In an experimental group, robot-assisted chin osteotomy was automatically performed in 12 models of 12 patients according to the preoperative virtual surgical planning (VSP). In a control group, with the assistance of a surgical guide, a surgeon performed the chin osteotomy in another 12 models of the same patients. All the mandibular osteotomies were successfully completed, and then the distance error and direction error of the osteotomy plane were measured and analyzed. The overall distance errors of the osteotomy plane were 1.57 ± 0.26 mm in the experimental group and 1.55 ± 0.23 mm in the control group, and the direction errors were 7.99 ± 1.10° in the experimental group and 8.61 ± 1.05° in the control group. The Bland-Altman analysis results revealed that the distance error of 91.7% (11/12) and the direction error of 100% (12/12) of the osteotomy plane were within the 95% limits of agreement, suggesting the consistency of differences in the osteotomy planes between the two groups. Robot-assisted chin osteotomy is a feasible auxiliary technology and achieves the accuracy level of surgical guide-assisted manual operation.
Collapse
Affiliation(s)
- Jinyang Wu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Wenyu Hui
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Department of Stomatology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Jianhua Huang
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Nan Luan
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yanping Lin
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Correspondence: (Y.Z.); (S.Z.); Tel.: +86-021-2327-1699-5656 (Y.Z. & S.Z.); Fax: +86-021-6313-6856 (Y.Z. & S.Z.)
| | - Shilei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Correspondence: (Y.Z.); (S.Z.); Tel.: +86-021-2327-1699-5656 (Y.Z. & S.Z.); Fax: +86-021-6313-6856 (Y.Z. & S.Z.)
| |
Collapse
|
6
|
Honigmann P, Hofer M, Hirsch S, Morawska M, Müller‐Gerbl M, Thieringer FM, Coppo E. Cold ablation robot‐guided laser osteotomy in hand, wrist and forearm surgery—A feasibility study. Int J Med Robot 2022; 18:e2438. [PMID: 35770622 PMCID: PMC9541476 DOI: 10.1002/rcs.2438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Abstract
Introduction Traditional bone surgery using saws and chisels is associated with direct contact of instruments with the bone causing friction, heat and pressure and hence, damaging the bone and the surrounding soft tissues. Method Cold ablation laser osteotomy offers new possibilities to perform corrective osteotomies in the field of bone surgery. We introduce the technology of navigated cold ablation robot‐guided laser osteotomy, present potential applications, and preliminary pre‐clinical cadaver test results in the field of hand‐, wrist‐ and forearm surgery. Results The cadaver tests showed first promising results for corrections in all planes and axes using different cutting patterns. Conclusion Cold ablation laser osteotomy seems to be a feasible new method to perform osteotomies in the field of hand‐, wrist‐ and forearm surgery. Primary osseous stability could be achieved using various cutting patterns which could lead to reduction of the amount of hardware required for osteosynthesis. Further tests are required to proof the latter and precision.
Collapse
Affiliation(s)
- Philipp Honigmann
- Hand and Peripheral Nerve Surgery Department of Orthopaedic Surgery and Traumatology Kantonsspital Baselland (Bruderholz, Liestal, Laufen) Bruderholz Switzerland
- Department of Biomedical Engineering Medical Additive Manufacturing Research Group (MAM) University of Basel Allschwil Switzerland
- Department of Biomedical Engineering and Physics Amsterdam UMC University of Amsterdam Amsterdam Movement Sciences Amsterdam The Netherlands
- Faculty of Medicine University of Basel Basel Switzerland
| | - Maximilian Hofer
- Department of Biomedical Engineering Medical Additive Manufacturing Research Group (MAM) University of Basel Allschwil Switzerland
- Faculty of Medicine University of Basel Basel Switzerland
| | | | | | - Magdalena Müller‐Gerbl
- Faculty of Medicine University of Basel Basel Switzerland
- Institute of Anatomy University Basel Basel Switzerland
| | - Florian M. Thieringer
- Department of Biomedical Engineering Medical Additive Manufacturing Research Group (MAM) University of Basel Allschwil Switzerland
- Faculty of Medicine University of Basel Basel Switzerland
- Department of Oral and Cranio‐Maxillofacial Surgery University Hospital Basel Basel Switzerland
| | - Enrico Coppo
- Hand and Peripheral Nerve Surgery Department of Orthopaedic Surgery and Traumatology Kantonsspital Baselland (Bruderholz, Liestal, Laufen) Bruderholz Switzerland
- Department of Biomedical Engineering Medical Additive Manufacturing Research Group (MAM) University of Basel Allschwil Switzerland
| |
Collapse
|
7
|
Ha TT, Thieringer FM, Bammerlin M, Cordier D. High Precision Bone Cutting by Er: YAG Lasers Might Minimize the Invasiveness of Navigated Brain Biopsies. Front Oncol 2022; 11:690374. [PMID: 35047381 PMCID: PMC8762267 DOI: 10.3389/fonc.2021.690374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Biopsies of brain tissue are sampled and examined to establish a diagnosis and to plan further treatment, e.g. for brain tumors. The neurosurgical procedure of sampling brain tissue for histologic examination is still a relatively invasive procedure that carries several disadvantages. The “proof of concept”-objective of this study is to answer the question if laser technology might be a potential tool to make brain biopsies less invasive, faster and safer. Laser technology might carry the opportunity to miniaturize the necessary burr hole and also to angulate the burr hole much more tangential in relation to the bone surface in order to take biopsies from brain regions that are usually only difficult and hazardous to access. We examined if it is possible to miniaturize the hole in the skull bone to such a high extent that potentially the laser-created canal itself may guide the biopsy needle with sufficient accuracy. The 2-dimensional, i.e. radial tolerance of the tip of biopsy needles inserted in these canals was measured under defined lateral loads which mimic mechanical forces applied by a surgeon. The canals through the skull bones were planned in angles of 90° (perpendicular) and 45° relative to the bone surface. We created a total of 33 holes with an Er : YAG laser in human skull bones. We could demonstrate that the achievable radial tolerance concerning the guidance of a biopsy needle by a laser created bone canal is within the range of the actual accuracy of a usual navigated device if the canal is at least 4 mm in length. Lateral mechanical loads applied to the biopsy needle had only minor impact on the measurable radial tolerance. Furthermore, in contrast to mechanical drilling systems, laser technology enables the creation of bone canals in pointed angles to the skull bone surface. The latter opens the perspective to sample biopsies in brain areas that are usually not or only hazardous to access.
Collapse
Affiliation(s)
- Thanh Tu Ha
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Florian M Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | | | - Dominik Cordier
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
8
|
Cold Ablation Robot-Guided Laser Osteotome (CARLO ®): From Bench to Bedside. J Clin Med 2021; 10:jcm10030450. [PMID: 33498921 PMCID: PMC7865977 DOI: 10.3390/jcm10030450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®). Methods: The CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. Results: The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. Conclusion: The newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape.
Collapse
|