New strategies for high precision surgery of the temporal bone using a robotic approach for cochlear implantation.

The aim of the study was to demonstrate a collision-free trajectory of an instrument through the facial recess to the site of planned cochleostomy guided by a surgery robot. The indication for cochlear implantation is still expanding toward more substantial residual hearing. A cochleostomy as atraumatic as possible will influence the preservation of inner ear function. The employment of a highly precise instrument guidance using a robot could represent a feasible solution for a constant reproducible surgical procedure. Screw markers for a point-based registration were fixed on a human temporal bone specimen prepared with a mastoidectomy and posterior tympanotomy. A DICOM dataset has been generated thereof in a 64-multislice computer tomography (CT). A virtual trajectory in a 3D model has been planned representing the path of instrumentation toward the desired spot of cochleostomy. A 1.9-mm endoscope has been mounted onto the robot system RobaCKa (Staeubli RX90CR) to visualize this trajectory. The target registration error added up to 0.25 mm, which met the desirable tolerance of <0.5 mm. A collision-free propagation of the endoscope into the tympanic cavity via the facial recess has been performed by the robot and the spot of cochleostomy could be visualized through the endoscope. Using a DICOM dataset of a high-resolution CT and a robot as a positioning platform for surgical instruments could be a feasible approach to perform a highly precise and constant reproducible cochleostomy. Furthermore, it could be a crucial step to preserve substantial residual hearing in terms of expanding the indications for cochlear implantation.

Chromatic confocal spectral interferometry.

Chromatic confocal spectral interferometry (CCSI) is a novel scheme for topography measurements that combines the techniques of spectral interferometry and chromatic confocal microscopy. This hybrid method allows for white-light interferometric detection with a high NA in a single-shot manner. To the best of our knowledge, CCSI is the first interferometric method that utilizes a confocally filtered and chromatically dispersed focus for detection and simultaneously allows for retrieval of the depth position of reflecting or scattering objects utilizing the phase (modulation frequency) of the interferometric signals acquired. With the chromatically dispersed focus, the depth range of the sensor is decoupled from the NA of the microscope objective.

Chromatically dispersed interferometry with wavelet analysis.

A new white-light interferometry point sensor utilizing a chromatically dispersed depth detection field is addressed. Monitoring the interference in the optical frequency domain allows for microscopic height detection without the necessity of a mechanical axial scan. The problem of limited dynamic range in previously reported spectral interferometric schemes is solved by forming a high-contrast interference window due to the chromatically dispersed focusing of the detection field. In a proof-of-principle experiment, the position of a reflecting object could be retrieved with a focus of 0.8 NA over an axial range of 30 microm by analyzing the phase of the emerging interference wavelets.