Robotic Guidance for Microsurgical Laser Bone Processing in ENT Surgery

Burgner, Jessica; Kahrs, Lüder A; Raczkowsky, Jörg; Schipper, Jörg; Klenzner, Thomas; Wörn, Heinz
Robotics Science and Systems, Workshop on Enabling Technologies for Image-Guided Interventional Procedures, pp. 18–21, 2010
Robotic Guidance for Microsurgical Laser Bone Processing in ENT Surgery


Minimal traumatic interventions on bony tissue ne-cessitate development of image-guided and robot assisted surgerymethods suitable to achieve high accuracy and precision. In caseof ENT surgery cochlear implantation (CI) is a prime examplefor microsurgical requirements. Laser ablation as a contact-freemethod allows microsurgical bone removal and in combinationwith robot guidance inherits a high potential. A prototype systemwas established, consisting of a robot positioning a scan headwhich deflects the laser with high accuracy. Further, a microscopeguarantees visual observation in a way familiar to surgeons.The overall workflow includes preoperative planning and sim-ulation of the cochleostomy procedure. During the intervention,the surgeon is inspecting the progress through the surgicalmicroscope and can adjust the laser pulse positions at any time.Laser ablation is further controlled by visual servoing, allowingautomatic pulse adjustment in case of approaching the innerlining membrane of the cochlea.The integrated setup was evaluated in an experimental oper-ating room. Preoperative planning was performed on a three-dimensional model of an ex-vivo human temporal bone. Thetarget point on the promontory and the desired cochleostomyangle was chosen. After registration the robot automaticallypositioned the scan head into the correct preplanned location inrespect to the temporal bone and the cochleostomy with diameterof 0.6 mm could be performed successfully.