Design and analysis of a head-mounted parallel kinematic device for skull surgery.

PURPOSE: Precision skull surgery requires specialized instrumentation to satisfy demanding requirements in cochlear array implantation, deep brain stimulation electrode placement, and related applications. A miniaturized reconfigurable parallel kinematic mechanism which can be directly mounted on a patient's skull was designed, built, and tested for precision skull surgery. METHODS: A Stewart-Gough platform is attached to a patient's skull so no optical tracking affecting the overall accuracy in keyhole surgery is required. Six bone anchors comprising the mechanism base joints are implanted at positions with sufficient skull thickness. Since no fixation frame is required, intervention planning flexibility is increased. The centers of the spherical shaped bone anchors can be localized accurately in the image space. An implicit registration to the physical space is performed by assembling the kinematics. Registration error is minimized compared to common optical tracker-based approaches. Due to the reconfigurable mechanism, an optimization of the hexapod's configuration is needed to maximize accuracy and mechanical stability during the incision. Mathematical simulation was conducted to estimate system performance. RESULTS: Simulation results revealed significant improvement in accuracy and stability when exploiting the redundant degrees of freedom and the implemented reconfigurability. Inaccurate localization of base points in the image data set was identified as the main source of error. A first prototype with passive prismatic actuators, i.e. micrometer calipers, was successfully built. CONCLUSIONS: A head-mounted parallel kinematic device for high precision skull surgery was developed that provides submillimetric accuracy in straight-line incisions. The system offers enhanced flexibility due to the absence of a rigid fixation frame.

Robotic mastoidectomy.

HYPOTHESIS: Using image-guided surgical techniques, we propose that an industrial robot can be programmed to safely, effectively, and efficiently perform a mastoidectomy. BACKGROUND: Whereas robotics is a mature field in many surgical applications, robots have yet to be clinically used in otologic surgery despite significant advantages including reliability and precision. METHODS: We designed a robotic system that incorporates custom software with an industrial robot to manipulate a surgical drill through a complex milling profile. The software controls the movements of the robot based on real-time feedback from a commercially available optical tracking system. The desired path of the drill to remove the desired volume of mastoid bone was planned using computed tomographic scans of cadaveric specimens and then implemented using the robotic system. Bone-implanted fiducial markers were used to provide accurate registration between computed tomographic and physical space. RESULTS: A mastoid cavity was milled on 3 cadaveric specimens with a 5-mm fluted ball bit. Postmilling computed tomographic scans showed that, for the 3 specimens, 97.70%, 99.99%, and 96.05% of the target region was ablated without violation of any critical feature. CONCLUSION: To the best of our knowledge, this is the first time that a robot has been used to perform a mastoidectomy. Although significant hurdles remain to translate this technology to clinical use, we have shown that it is feasible. The prospect of reducing surgical time and enhancing patient safety by replacing human hand-eye coordination with machine precision motivates future work toward translating this technique to clinical use.

A robot-guided minimally invasive approach for cochlear implant surgery: preliminary results of a temporal bone study.

PURPOSE: The aim of this study was to create an access canal to the inner ear, by drilling, and perform the cochleostomy for cochlear implant surgery using robot guidance. METHODS: A robot, a surgical drill and an Image-Guided Surgery (IGS) system were combined in a closed-loop setup. Ten temporal bones were scanned at the planning stages of the procedure. The robot guided the drill along the preplanned trajectory and created the approach. Postoperative scans were obtained. RESULTS: The cochleostomy was performed completely in nine out of ten cases. This did not prove possible for one of the specimens, the target site selected being in too superficial a location in relation to the round window. No violation of the facial nerve took place, although the chorda tympani nerve was violated in one case and the stapes in two. It was obvious during preoperative planning that these structures would be violated, but this was accepted in order to maintain a safety margin from the facial nerve. No other unforeseen damage occurred. CONCLUSIONS: This preliminary study suggests that robot-guided drilling of a minimally invasive approach to the cochlea might be feasible, but further improvements are necessary before any clinical application becomes possible. Where the width of the facial recess is less than 2.5 mm, the chorda tympani nerve and the ossicles are at risk.

Conception and design of an automated insertion tool for cochlear implants.

Cochlear implants (CI) are electronic devices incorporating an electrode inserted into the human cochlea for direct electric stimulation of the auditory nerve. The implantation has become the standard treatment for patients with severe-to-profound sensorineural loss not aidable with conventional hearing aids. The state of the art operative technique is a facial recess approach to the middle ear, following the opening of the scala tympani (cochleostomy) and insertion of the electrode array. The facial recess approach is applicable only by experienced surgeons and optimal CI results primarily depend on optimal electrode placement and minimal traumatic insertion. This also requires a certain amount of experience. Additionally several groups work on minimally-invasive approaches to the cochlea, resulting in the necessity to insert the implant via a keyhole access, which is not applicable with current techniques. This paper presents a mechatronic device for an automated insertion of the electrode array of a cochlear implant system. Being designed especially for minimally-invasive approaches, the tool is also applicable for regular facial recess approaches. Moreover the device allows reliable and repeatable insertion studies at synthetic models or cadaver specimen. The functionality of the tool is proofed with first experiments on a synthetic model.

Construction and establishment of a new environmental chamber to study real-time cardiac development.

Heart development, especially the critical phase of cardiac looping, is a complex and intricate process that has not yet been visualized "live" over long periods of time. We have constructed and established a new environmental incubator chamber that provides stable conditions for embryonic development with regard to temperature, humidity, and oxygen levels. We have integrated a video microscope in the chamber to visualize the developing heart in real time and present the first "live" recordings of a chick embryo in shell-less culture acquired over a period of 2 days. The time-lapse images we show depict a significant time window that covers the most critical and typical morphogenetic events during normal cardiac looping. Our system is of interest to researchers in the field of embryogenesis, as it can be adapted to a variety of animal models for organogenesis studies including heart and limb development.