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Al-Bourgol S, Machinet G, Bakkali A, Faucon M, Gemini L. Real-Time Monitoring of Thermal Phenomena during Femtosecond Ablation of Bone Tissue for Process Control. Bioengineering (Basel) 2024; 11:309. [PMID: 38671731 PMCID: PMC11047677 DOI: 10.3390/bioengineering11040309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Femtosecond (fs) laser technology is currently being considered in innovative fields such as osteotomy and treatment of hard tissue thanks to the achievable high resolution and ability to prevent tissue damage. In a previous study, suitable process parameters were obtained to achieve competitive ablation rates on pork femur processing. Nevertheless, a better control of thermal accumulation in the tissue during laser ablation could further improve the postoperative regeneration of the treated bone compared with conventional procedures and push forward the exploitation of such technology. This study presents methods for real time analyses of bone tissue temperature and composition during fs laser ablation and highlights the importance of implementing an efficient cooling method of bone tissue in order to achieve optimized results. Results show that it is possible to achieve a larger process window for bone tissue ablation where bone tissue temperature remains within the protein denaturation temperature in water-based processing environment. This is a key outcome towards a clinical exploitation of the presented technology, where higher process throughputs are necessary. The effects of process parameters and environments on bone tissue were confirmed by LIBS technique, which proved to be an efficient method by which to record real-time variation of bone tissue composition during laser irradiation.
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Affiliation(s)
| | | | | | | | - Laura Gemini
- ALPhANOV, Institut d’Optique d’Aquitaine, 33400 Talence, France; (S.A.-B.); (M.F.)
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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.
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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.
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First-Hand Experience and Result with New Robot-Assisted Laser LeFort-I Osteotomy in Orthognathic Surgery: A Case Report. J Pers Med 2023; 13:jpm13020287. [PMID: 36836521 PMCID: PMC9962026 DOI: 10.3390/jpm13020287] [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: 01/14/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND We report the world's first developer-independent experience with robot-assisted laser Le Fort I osteotomy (LLFO) and drill-hole marking in orthognathic surgery. To overcome the geometric limitations of conventional rotating and piezosurgical instruments for performing osteotomies, we used the stand-alone robot-assisted laser system developed by Advanced Osteotomy Tools. The aim here was to evaluate the precision of this novel procedure in comparison to the standard procedure used in our clinic using a computer-aided design/computer-aided manufacturing (CAD/CAM) cutting guide and patient-specific implant. METHODS A linear Le-Fort-I osteotomy was digitally planned and transferred to the robot. The linear portion of the Le-Fort I osteotomy was performed autonomously by the robot under direct visual control. Accuracy was analyzed by superimposing preoperative and postoperative computed tomography images, and verified intraoperatively using prefabricated patient-specific implant. RESULTS The robot performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 1.5 mm on average between the planned and the performed osteotomy. In the robot-assisted intraoperative drillhole marking of the maxilla, which was performed for the first time worldwide, were no measurable deviations between planning and actual positioning. CONCLUSION Robotic-assisted orthognathic surgery could be a useful adjunct to conventional drills, burrs, and piezosurgical instruments for performing osteotomies. However, the time required for the actual osteotomy as well as isolated minor design aspects of the Dynamic Reference Frame (DRF), among other things, still need to be improved. Still further studies for final evaluation of safety and accuracy are also needed.
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Orthopedics-Related Applications of Ultrafast Laser and Its Recent Advances. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The potential of ultrafast lasers (pico- to femtosecond) in orthopedics-related procedures has been studied extensively for clinical adoption. As compared to conventional laser systems with continuous wave or longer wave pulse, ultrafast lasers provide advantages such as higher precision and minimal collateral thermal damages. Translation to surgical applications in the clinic has been restrained by limitations of material removal rate and pulse average power, whereas the use in surface texturing of implants has become more refined to greatly improve bioactivation and osteointegration within bone matrices. With recent advances, we review the advantages and limitations of ultrafast lasers, specifically in orthopedic bone ablation as well as bone implant laser texturing, and consider the difficulties encountered within orthopedic surgical applications where ultrafast lasers could provide a benefit. We conclude by proposing our perspectives on applications where ultrafast lasers could be of advantage, specifically due to the non-thermal nature of ablation and control of cutting.
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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.
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Jivraj J, Chen C, Barrows D, Gu X, Yang VXD. Optimization of laser osteotomy at 1064 nm using a graphite topical absorber and a nitrogen assist gas jet. BIOMEDICAL OPTICS EXPRESS 2019; 10:3114-3123. [PMID: 31467772 PMCID: PMC6706023 DOI: 10.1364/boe.10.003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 06/10/2023]
Abstract
Laser ablation of bone for the purposes of osteotomy is not as well understood as ablation of homogeneous, non-biological materials such as metals and plastics. Ignition times and etch rate can vary during ablation of cortical bone. In this study, we propose the use of two techniques to optimize bone ablation at 1064nm using a coaxial nitrogen jet as an assist gas and topical application of graphite as a highly absorbing chromophore. We show a two order of magnitude reduction in mean time to ignition and variance by using the graphite topical chromophore. We also show that an increase in volumetric flow rate of the assist gas jet does show an initial increase in etch rate, but increased pressure beyond a certain point shows decreased return. This study also demonstrates a 2 nd order relationship between exposure time, volumetric flow rate of nitrogen, and etch rate of cortical bone. The results of this study can be used to optimize the performance of laser ablation systems for osteotomy. This is a companion study to an earlier one carried out by Wong et al. [Biomedical Opt. Express6, 1 (2015)].
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Affiliation(s)
- Jamil Jivraj
- Biophotonics and Bioengineering Lab, Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Chaoliang Chen
- Biophotonics and Bioengineering Lab, Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada
| | | | - Xijia Gu
- Fiber Optics Communications and Sensing Lab, Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Victor X D Yang
- Biophotonics and Bioengineering Lab, Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Ontario, Canada
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Yakovlev E, Shandybina G, Shamova A. Modelling of the heat accumulation process during short and ultrashort pulsed laser irradiation of bone tissue. BIOMEDICAL OPTICS EXPRESS 2019; 10:3030-3040. [PMID: 31259072 PMCID: PMC6583351 DOI: 10.1364/boe.10.003030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 06/09/2023]
Abstract
An analytical model is presented that qualitatively describes the cooling of a biological tissue after irradiation with short and ultrashort laser pulses. The assumption that the distribution of temperature at the initial moment of surface cooling repeats the distribution of the absorbed laser energy allowed us to use the thermal conductivity approximation in both cases. The experimental results of irradiation of dry bone with nanosecond and femtosecond laser pulses are compared with the calculated data. The necessity of taking into account the change in the optical parameters of hard tissue in the field of laser irradiation during its treatment by nanosecond and femtosecond laser pulses and the key role of residual heating in its carbonization around the exposure region is shown. The application of the model to a particular biological tissue can significantly simplify the search for optimal parameters of lasers for surgical procedures.
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Influences of different lower cervical bone graft heights on the size of the intervertebral foramen: multiple planar dynamic measurements with laser scanning. Lasers Med Sci 2018; 33:627-635. [PMID: 29383502 DOI: 10.1007/s10103-018-2452-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
The aim of this study is to evaluate the influences of different bone graft heights on the size of the intervertebral foramen, which will help determine the optimal graft height in clinical practice. Six fresh adult cadavers were used, with the C5-C6 vertebral column segment defined as the functional spinal unit (FSU). After discectomy, the C5/6 intervertebral height was set as the baseline height (normal disc height). We initially used spiral computed tomography (CT) to scan and measure the middle area of the intervertebral foramen when at the baseline height. Data regarding the spatial relationship of C5-C6 were subsequently collected with a laser scanner. Grafting with four different sized grafts, namely, grafts of 100, 130, 160, and 190% of the baseline height, was implanted. Moreover, we scanned to display the FSU in the four different states using Geomagic8.0 studio software. Multiple planar dynamic measurements (MPDM) were adopted to measure the intervertebral foramen volume, middle area, and areas of internal and external opening. MPDM with a laser scanner precisely measured the middle area of the intervertebral foramen as spiral CT, and it is easy to simulate the different grafts implanted. With the increase of the bone graft height, the size of the intervertebral foramen began to decrease after it increased to a certain point, when grafts of 160% of the baseline height implanted. MPDM of the intervertebral foramens with laser scanning three-dimensional (3D) reconstitution are relatively objective and accurate. The recommended optimal graft height of cervical spondylosis is 160% of the mean height of adjacent normal intervertebral spaces.
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Troedhan A, Mahmoud ZT, Wainwright M, Khamis MM. Cutting bone with drills, burs, lasers and piezotomes: A comprehensive systematic review and recommendations for the clinician. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/2455-4634.000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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10
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The In Vivo Effect of Ytterbium-Doped Fiber Laser on Rat Buccal Mucosa as a Simulation of Its Effect on the Urinary Tract: A Preclinical Histopathological Evaluation. Int Neurourol J 2017; 21:S17-23. [PMID: 28446013 PMCID: PMC5426434 DOI: 10.5213/inj.1734858.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/02/2017] [Indexed: 11/08/2022] Open
Abstract
Purpose The aim of this study was to perform a histological analysis of the effect of a ytterbium-doped fiber (YDF) laser on oral buccal mucosa tissue in vivo to simulate its effect on the mucosa of the lower urinary tract. Methods A total of 90 8-week-old Sprague-Dawley rats were anesthetized with urethrane (1.2 g/kg intraperitoneally). A prespecified inner buccal mucosal site was irradiated with a YDF master-oscillator power amplifier (MOPA) system for 60 seconds, with output power settings of 0.5, 1, and 2 W, respectively, in 3 treatment groups. Specimens of irradiated tissue were harvested at 2 hours, 24 hours, 2 weeks, and 4 weeks after irradiation. The tissue specimens were stained with hematoxylin and eosin for histological analysis. Results In the group treated with 0.5 W, basal cell elongation and vacuolization were observed at 2 hours and 24 hours after treatment, respectively. No evident injury was observed after 2 or 4 weeks. The group treated with 1 W presented partial basal layer separation, and even complete epidermal ablation, within 2 hours. At 24 hours after laser treatment, new capillaries on an edematous background of fibroblasts and myofibroblasts, as well as profuse infiltration of the neutrophils to the basal layer, were observed. Collagen deposition and reepithelization were observed in specimens taken 2 weeks and 4 weeks after treatment. The group treated with 2 W presented bigger and deeper injuries at 2 hours after irradiation. Meanwhile, subepidermal bullae with full-thickness epidermal necrosis and underlying inflammatory infiltrate were observed 24 hours after treatment. The presence of fibrous connective tissue and collagen deposition were observed 2 weeks and 4 weeks after the treatment. Conclusions To our knowledge, this is the first report regarding the effect of a YDF laser on living tissue. Our study demonstrated that the typical histological findings of the tissue reaction to the YDF MOPA apparatus were very similar to those associated with thermal injuries. The extent and degree of tissue damage increased proportionally to the output power.
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Rajitha Gunaratne GD, Khan R, Fick D, Robertson B, Dahotre N, Ironside C. A review of the physiological and histological effects of laser osteotomy. J Med Eng Technol 2016; 41:1-12. [DOI: 10.1080/03091902.2016.1199743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Yin C, Ruzzante SW, Fraser JM. Automated 3D bone ablation with 1,070 nm ytterbium‐doped fiber laser enabled by inline coherent imaging. Lasers Surg Med 2015; 48:288-98. [DOI: 10.1002/lsm.22459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Chenman Yin
- Department of Physics, Engineering Physics and AstronomyQueen's UniversityKingstonOntarioCanadaK7L 3N6
| | - Sacha W. Ruzzante
- Department of Physics, Engineering Physics and AstronomyQueen's UniversityKingstonOntarioCanadaK7L 3N6
| | - James M. Fraser
- Department of Physics, Engineering Physics and AstronomyQueen's UniversityKingstonOntarioCanadaK7L 3N6
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Baek KW, Deibel W, Marinov D, Griessen M, Bruno A, Zeilhofer HF, Cattin P, Juergens P. Clinical applicability of robot-guided contact-free laser osteotomy in cranio-maxillo-facial surgery: in-vitro simulation and in-vivo surgery in minipig mandibles. Br J Oral Maxillofac Surg 2015; 53:976-81. [PMID: 26305341 DOI: 10.1016/j.bjoms.2015.07.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
Abstract
Laser was being used in medicine soon after its invention. However, it has been possible to excise hard tissue with lasers only recently, and the Er:YAG laser is now established in the treatment of damaged teeth. Recently experimental studies have investigated its use in bone surgery, where its major advantages are freedom of cutting geometry and precision. However, these advantages become apparent only when the system is used with robotic guidance. The main challenge is ergonomic integration of the laser and the robot, otherwise the surgeon's space in the operating theatre is obstructed during the procedure. Here we present our first experiences with an integrated, miniaturised laser system guided by a surgical robot. An Er:YAG laser source and the corresponding optical system were integrated into a composite casing that was mounted on a surgical robotic arm. The robot-guided laser system was connected to a computer-assisted preoperative planning and intraoperative navigation system, and the laser osteotome was used in an operating theatre to create defects of different shapes in the mandibles of 6 minipigs. Similar defects were created on the opposite side with a piezoelectric (PZE) osteotome and a conventional drill guided by a surgeon. The performance was analysed from the points of view of the workflow, ergonomics, ease of use, and safety features. The integrated robot-guided laser osteotome can be ergonomically used in the operating theatre. The computer-assisted and robot-guided laser osteotome is likely to be suitable for clinical use for ostectomies that require considerable accuracy and individual shape.
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Affiliation(s)
- K-W Baek
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - W Deibel
- Medical Image Analysis Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland; Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - D Marinov
- Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - M Griessen
- Medical Image Analysis Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland; Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - A Bruno
- Advanced Osteotomy Tools AG, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - H-F Zeilhofer
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - Ph Cattin
- Medical Image Analysis Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
| | - Ph Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland.
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Baek KW, Deibel W, Marinov D, Griessen M, Dard M, Bruno A, Zeilhofer HF, Cattin P, Juergens P. A comparative investigation of bone surface after cutting with mechanical tools and Er:YAG laser. Lasers Surg Med 2015; 47:426-32. [PMID: 25945815 DOI: 10.1002/lsm.22352] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite of the long history of medical application, laser ablation of bone tissue became successful only recently. Laser bone cutting is proven to have higher accuracy and to increase bone healing compared to conventional mechanical bone cutting. But the reason of subsequent better healing is not biologically explained yet. In this study we present our experience with an integrated miniaturized laser system mounted on a surgical lightweight robotic arm. STUDY DESIGN/MATERIALS AND METHODS An Erbium-doped Yttrium Aluminium Garnet (Er:YAG) laser and a piezoelectric (PZE) osteotome were used for comparison. In six grown up female Göttingen minipigs, comparative surgical interventions were done on the edentulous mandibular ridge. Our laser system was used to create different shapes of bone defects on the left side of the mandible. On the contralateral side, similar bone defects were created by PZE osteotome. Small bone samples were harvested to compare the immediate post-operative cut surface. RESULTS The analysis of the cut surface of the laser osteotomy and conventional mechanical osteotomy revealed an essential difference. The scanning electron microscopy (SEM) analysis showed biologically open cut surfaces from the laser osteotomy. The samples from PZE osteotomy showed a flattened tissue structure over the cut surface, resembling the "smear layer" from tooth preparation. CONCLUSIONS We concluded that our new finding with the mechanical osteotomy suggests a biological explanation to the expected difference in subsequent bone healing. Our hypothesis is that the difference of surface characteristic yields to different bleeding pattern and subsequently results in different bone healing. The analyses of bone healing will support our hypothesis.
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Affiliation(s)
- Kyung-Won Baek
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, Basel, 4031, Switzerland
| | - Waldemar Deibel
- Medical Image Analysis Centre, University of Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Dilyan Marinov
- Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Mathias Griessen
- Medical Image Analysis Centre, University of Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Michel Dard
- Periodontology and Implant Dentistry, New York University College of Dentistry, 345E. 24th Street, New York City, 10010
| | - Alfredo Bruno
- Advanced Osteotomy Tools AG, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Hans-Florian Zeilhofer
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, Basel, 4031, Switzerland
| | - Philippe Cattin
- Medical Image Analysis Centre, University of Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Philipp Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,Hightech Research Centre of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, Basel, 4031, Switzerland
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