Navigated, Robot-Driven Laser Craniotomy for SEEG Application Using Optical Coherence Tomography in an Animal Model.

Objectives: We recently introduced a navigated, robot-driven laser beam craniotomy for use with stereoelectroencephalography (SEEG) applications. This method was intended to substitute the hand-held electric power drill in an ex vivo study. The purpose of this in vivo non-recovery pilot study was to acquire data for the depth control unit of this laser device, to test the feasibility of cutting bone channels, and to assess dura perforation and possible cortex damage related to cold ablation. Methods: Multiple holes suitable for SEEG bone channels were planned for the superior portion of two pig craniums using surgical planning software and a frameless, navigated technique. The trajectories were planned to avoid cortical blood vessels using magnetic resonance angiography. Each trajectory was converted into a series of circular paths to cut bone channels. The cutting strategy for each hole involved two modes: a remaining bone thickness mode and a cut through mode (CTR). The remaining bone thickness mode is an automatic coarse approach where the cutting depth is measured in real time using optical coherence tomography (OCT). In this mode, a pre-set measurement, in mm, of the remaining bone is left over by automatically comparing the bone thickness from computed tomography with the OCT depth. In the CTR mode, the cut through at lower cutting energies is managed by observing the cutting site with real-time video. Results: Both anesthesia protocols did not show any irregularities. In total, 19 bone channels were cut in both specimens. All channels were executed according to the planned cutting strategy using the frameless navigation of the robot-driven laser device. The dura showed minor damage after one laser beam and severe damage after two and three laser beams. The cortex was not damaged. As soon as the cut through was obtained, we observed that moderate cerebrospinal fluid leakage impeded the cutting efficiency and interfered with the visualization for depth control. The coaxial camera showed a live video feed in which cut through of the bone could be identified in 84%. Conclusion: Inflowing cerebrospinal fluid disturbed OCT signals, and, therefore, the current CTR method could not be reliably applied. Video imaging is a candidate for observing a successful cut through. OCT and video imaging may be used for depth control to implement an updated SEEG bone channel cutting strategy in the future.

First-in-man application of a cold ablation robot guided laser osteotome in midface osteotomies.

The aim of the study was to assess the clinical applicability of robot guided laser osteotomy for clinical application. This is the initial report on 14 consecutive patients requiring an orthognathic procedure with a midface osteotomy (no restrictions made on the surgical indication itself) who have undergone surgery by means of the Cold Ablation Laser Osteotome CARLO® (AOT Advanced Osteotomy Tools, Basle, Switzerland), which is an integrated system, functionally comprising: an Er:YAG laser source, intended to perform osteotomies using cold laser ablation, a robot arm that controls the position of the laser source, an optical tracking device that provides a continuous and accurate measurement of the position of the laser source and of reference elements attached to instruments or bones, a navigation system (software) that is able to read preoperatively defined planned osteotomies, and - under the control of a surgeon - performs the planned osteotomies. Safety was assessed by unimpaired postoperative healing and the absence of device related injuries; performance was assessed as ability to cut the maxilla along the preoperatively planned cutting path with a rage of accuracy of 2mm. Cold ablation robot-guided laser osteotomy could successfully be performed in 14 consecutive patients. No intraoperative complications or technical failure occurred. All osteotomies were within an average deviation of 0.80 mm (±0.26 mm) of the virtually preplanned location. The registration procedure to set up the robot at the beginning of the operation required a mean time of 4.6 min (±5.3min). In this report we describe the effective and successful routine use of Cold ablation robot-guided laser osteotomy in an actual clinical setting. It is a promising technical innovation that has the potential to set new standards for accuracy and safety in orthognathic surgery.

Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside.

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.

Robotic Navigated Laser Craniotomy for Depth Electrode Implantation in Epilepsy Surgery: A Cadaver Lab Study.

OBJECTIVE: Depth electrode implantation for invasive monitoring in epilepsy surgery has become a standard procedure. We describe a new frameless stereotactic intervention using robot-guided laser beam for making precise bone channels for depth electrode placement. METHODS: A laboratory investigation on a head cadaver specimen was performed using a CT scan planning of depth electrodes in various positions. Precise bone channels were made by a navigated robot-driven laser beam (erbium:yttrium aluminum garnet [Er:YAG], 2.94-µm wavelength,) instead of twist drill holes. Entry point and target point precision was calculated using postimplantation CT scans and comparison to the preoperative trajectory plan. RESULTS: Frontal, parietal, and occipital bone channels for bolt implantation were made. The occipital bone channel had an angulation of more than 60 degrees to the surface. Bolts and depth electrodes were implanted solely guided by the trajectory given by the precise bone channels. The mean depth electrode length was 45.5 mm. Entry point deviation was 0.73 mm (±0.66 mm SD) and target point deviation was 2.0 mm (±0.64 mm SD). Bone channel laser time was ∼30 seconds per channel. Altogether, the implantation time was ∼10 to 15 minutes per electrode. CONCLUSION: Navigated robot-assisted laser for making precise bone channels for depth electrode implantation in epilepsy surgery is a promising new, exact and straightforward implantation technique and may have many advantages over twist drill hole implantation.

Precision measurement of the hydrogen 1S-2S frequency via a 920-km fiber link.

We have measured the frequency of the extremely narrow 1S-2S two-photon transition in atomic hydrogen using a remote cesium fountain clock with the help of a 920 km stabilized optical fiber. With an improved detection method we obtain f(1S-2S)=2466 061 413 187 018 (11) Hz with a relative uncertainty of 4.5×10(-15), confirming our previous measurement obtained with a local cesium clock [C. G. Parthey et al., Phys. Rev. Lett. 107, 203001 (2011)]. Combining these results with older measurements, we constrain the linear combinations of Lorentz boost symmetry violation parameters c((TX))=(3.1±1.9)×10(-11) and 0.92c((TY))+0.40c((TZ))=(2.6±5.3)×10(-11) in the standard model extension framework [D. Colladay, V. A. Kostelecký, Phys. Rev. D. 58, 116002 (1998)].

A spectrograph for exoplanet observations calibrated at the centimetre-per-second level.

The best spectrographs are limited in stability by their calibration light source. Laser frequency combs are the ideal calibrators for astronomical spectrographs. They emit a spectrum of lines that are equally spaced in frequency and that are as accurate and stable as the atomic clock relative to which the comb is stabilized. Absolute calibration provides the radial velocity of an astronomical object relative to the observer (on Earth). For the detection of Earth-mass exoplanets in Earth-like orbits around solar-type stars, or of cosmic acceleration, the observable is a tiny velocity change of less than 10 cm s(-1), where the repeatability of the calibration--the variation in stability across observations--is important. Hitherto, only laboratory systems or spectrograph calibrations of limited performance have been demonstrated. Here we report the calibration of an astronomical spectrograph with a short-term Doppler shift repeatability of 2.5 cm s(-1), and use it to monitor the star HD 75289 and recompute the orbit of its planet. This repeatability should make it possible to detect Earth-like planets in the habitable zone of star or even to measure the cosmic acceleration directly.

Improved measurement of the hydrogen 1S-2S transition frequency.

We have measured the 1S-2S transition frequency in atomic hydrogen via two-photon spectroscopy on a 5.8 K atomic beam. We obtain f(1S-2S) = 2,466,061,413,187,035 (10)  Hz for the hyperfine centroid, in agreement with, but 3.3 times better than the previous result [M. Fischer et al., Phys. Rev. Lett. 92, 230802 (2004)]. The improvement to a fractional frequency uncertainty of 4.2 × 10(-15) arises mainly from an improved stability of the spectroscopy laser, and a better determination of the main systematic uncertainties, namely, the second order Doppler and ac and dc Stark shifts. The probe laser frequency was phase coherently linked to the mobile cesium fountain clock FOM via a frequency comb.

Laser frequency combs for astronomical observations.

A direct measurement of the universe's expansion history could be made by observing in real time the evolution of the cosmological redshift of distant objects. However, this would require measurements of Doppler velocity drifts of approximately 1 centimeter per second per year, and astronomical spectrographs have not yet been calibrated to this tolerance. We demonstrated the first use of a laser frequency comb for wavelength calibration of an astronomical telescope. Even with a simple analysis, absolute calibration is achieved with an equivalent Doppler precision of approximately 9 meters per second at approximately 1.5 micrometers-beyond state-of-the-art accuracy. We show that tracking complex, time-varying systematic effects in the spectrograph and detector system is a particular advantage of laser frequency comb calibration. This technique promises an effective means for modeling and removal of such systematic effects to the accuracy required by future experiments to see direct evidence of the universe's putative acceleration.

Generation of low-timing-jitter femtosecond pulse trains with 2 GHz repetition rate via external repetition rate multiplication.

Generation of low-timing-jitter 150 fs pulse trains at 1560 nm with 2 GHz repetition rate is demonstrated by locking a 200 MHz fundamental polarization additive-pulse mode-locked erbium fiber laser to high-finesse external Fabry-Perot cavities. The timing jitter and relative intensity noise of the repetition-rate multiplied pulse train are investigated.