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Philipp Juergens - One of the best experts on this subject based on the ideXlab platform.
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cold ablation robot guided laser osteotome carlo from bench to bedside
Journal of Clinical Medicine, 2021Co-Authors: Matthias Ureel, Marcello Augello, Hans-florian Zeilhofer, Philipp Juergens, Daniel Holzinger, Tobias Wilken, Gabriele Millesi, Brittisabelle Berg, Andreas A MuellerAbstract: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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first in man application of a cold ablation robot guided laser osteotome in midface osteotomies
Journal of Cranio-maxillofacial Surgery, 2021Co-Authors: Daniel Holzinger, Matthias Ureel, Tobias Wilken, Andreas Albert Muller, Kurt Schicho, Gabriele Millesi, Philipp JuergensAbstract:Abstract Objective The aim of the study was to assess the clinical applicability of robot guided laser Osteotomy for clinical application. Material and Methods 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 assesd by unimpaired postoperative healing and the absence of device related injuries; performance was assesd as ability to cut the maxilla along the preoperatively planned cutting path with a rage of accuracy of 2mm. Results 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 minutes (±5.3min). Conclusion 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.
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comparing the bone healing after cold ablation robot guided er yag laser Osteotomy and piezoelectric Osteotomy a pilot study in a minipig mandible
Lasers in Surgery and Medicine, 2020Co-Authors: Kyungwon Baek, Philippe C. Cattin, Hans-florian Zeilhofer, Philipp Juergens, Michel DardAbstract:Background and objective To take major advantage of erbium-doped yttrium aluminium garnet (Er:YAG) lasers in Osteotomy-like freedom of cutting geometries and high accuracy-the integration and miniaturization of the robot, laser, and navigation technology was tried and applied to minipigs. The investigators hypothesized laser Osteotomy would render acceptable bone healing based on the intraoperative findings and postoperative cut surface analysis. Study design/materials and methods We designed and implemented a comparative bone-cutting surgery in the minipig mandible with a cold ablation robot-guided Er:YAG laser osteotome (CARLO) and a piezoelectric (PZE) osteotome. The sample was composed of different patterns of defects in the mandibles of six grown-up female Goettingen minipigs. The predictor variable was Er:YAG Osteotomy and PZE Osteotomy. The outcome variable was the cut surface characteristics and bone healing at 4 and 8 weeks postoperatively. Descriptive and qualitative comparison was executed. Results The sample was composed of four kinds of bone defects on both sides of the mandibles of six minipigs. We observed more bleeding during the operation, open-cut surfaces, and a faster healing pattern with the laser Osteotomy. There was a possible association between the intraoperative findings, postoperative cut surface analysis, and the bone healing pattern. Conclusions The results of this study suggest that characteristic open-cut surfaces could explain favorable bone healing after laser Osteotomy. Future studies will focus on the quantification of the early healing characteristics after laser Osteotomy, its diverse application, and the safety feature. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Performing partial mandibular resection, fibula free flap reconstruction and midfacial osteotomies with a cold ablation and robot-guided Er:YAG laser osteotome (CARLO®) – A study on applicability and effectiveness in human cadavers
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2018Co-Authors: Marcello Augello, Philippe C. Cattin, Cyrill Baetscher, Mireille Segesser, Hans-florian Zeilhofer, Philipp JuergensAbstract:Abstract Objective Aim of the study was to prove the safety, accuracy characteristics of contact-free laser Osteotomy executed with the cold ablation and robot-guided Er:YAG laser osteotome in a human cadaver test. Material and methods On six human cadavers mandible resections with a swallowtail like pattern were performed with the laser system on each side. The defects were reconstructed with a fibula graft of identical design and enlarged by 0.2 units. Mandibles and fibulas width as well surgery times were recorded. Additionally a Le Fort I and median mandible split were done. Macroscopically, the bone margins were examined for necrosis. Results Laser osteotomies of the mandible up to a depth of 23 mm were possible without any thermal damage. Repeatability and precision of the system could be easily assessed. With the navigation system precise control of localization was achievable. Mean surgery time for the mandible resection was 13.32 min and for the fibula Osteotomy 12.38 min. Conclusion The simply transmission of a cold ablation and robot-guided laser osteotome in an operation room identical environment for surgical interventions could be demonstrated. Precise Osteotomy patterns with freedom in the design and carbonisation-free cut surfaces have been shown.
Hans-florian Zeilhofer - One of the best experts on this subject based on the ideXlab platform.
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cold ablation robot guided laser osteotome carlo from bench to bedside
Journal of Clinical Medicine, 2021Co-Authors: Matthias Ureel, Marcello Augello, Hans-florian Zeilhofer, Philipp Juergens, Daniel Holzinger, Tobias Wilken, Gabriele Millesi, Brittisabelle Berg, Andreas A MuellerAbstract: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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comparing the bone healing after cold ablation robot guided er yag laser Osteotomy and piezoelectric Osteotomy a pilot study in a minipig mandible
Lasers in Surgery and Medicine, 2020Co-Authors: Kyungwon Baek, Philippe C. Cattin, Hans-florian Zeilhofer, Philipp Juergens, Michel DardAbstract:Background and objective To take major advantage of erbium-doped yttrium aluminium garnet (Er:YAG) lasers in Osteotomy-like freedom of cutting geometries and high accuracy-the integration and miniaturization of the robot, laser, and navigation technology was tried and applied to minipigs. The investigators hypothesized laser Osteotomy would render acceptable bone healing based on the intraoperative findings and postoperative cut surface analysis. Study design/materials and methods We designed and implemented a comparative bone-cutting surgery in the minipig mandible with a cold ablation robot-guided Er:YAG laser osteotome (CARLO) and a piezoelectric (PZE) osteotome. The sample was composed of different patterns of defects in the mandibles of six grown-up female Goettingen minipigs. The predictor variable was Er:YAG Osteotomy and PZE Osteotomy. The outcome variable was the cut surface characteristics and bone healing at 4 and 8 weeks postoperatively. Descriptive and qualitative comparison was executed. Results The sample was composed of four kinds of bone defects on both sides of the mandibles of six minipigs. We observed more bleeding during the operation, open-cut surfaces, and a faster healing pattern with the laser Osteotomy. There was a possible association between the intraoperative findings, postoperative cut surface analysis, and the bone healing pattern. Conclusions The results of this study suggest that characteristic open-cut surfaces could explain favorable bone healing after laser Osteotomy. Future studies will focus on the quantification of the early healing characteristics after laser Osteotomy, its diverse application, and the safety feature. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Performing partial mandibular resection, fibula free flap reconstruction and midfacial osteotomies with a cold ablation and robot-guided Er:YAG laser osteotome (CARLO®) – A study on applicability and effectiveness in human cadavers
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2018Co-Authors: Marcello Augello, Philippe C. Cattin, Cyrill Baetscher, Mireille Segesser, Hans-florian Zeilhofer, Philipp JuergensAbstract:Abstract Objective Aim of the study was to prove the safety, accuracy characteristics of contact-free laser Osteotomy executed with the cold ablation and robot-guided Er:YAG laser osteotome in a human cadaver test. Material and methods On six human cadavers mandible resections with a swallowtail like pattern were performed with the laser system on each side. The defects were reconstructed with a fibula graft of identical design and enlarged by 0.2 units. Mandibles and fibulas width as well surgery times were recorded. Additionally a Le Fort I and median mandible split were done. Macroscopically, the bone margins were examined for necrosis. Results Laser osteotomies of the mandible up to a depth of 23 mm were possible without any thermal damage. Repeatability and precision of the system could be easily assessed. With the navigation system precise control of localization was achievable. Mean surgery time for the mandible resection was 13.32 min and for the fibula Osteotomy 12.38 min. Conclusion The simply transmission of a cold ablation and robot-guided laser osteotome in an operation room identical environment for surgical interventions could be demonstrated. Precise Osteotomy patterns with freedom in the design and carbonisation-free cut surfaces have been shown.
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in vivo animal trials with a scanning co2 laser osteotome
Lasers in Surgery and Medicine, 2005Co-Authors: Mikhail Ivanenko, Hans-florian Zeilhofer, Martin Werner, Robert Sader, Said Afilal, Martina Hartstock, Christian Von Hanisch, Stefan Milz, Wolf Erhardt, Peter HeringAbstract:Background and Objectives We report first results of animal trials using an improved laser Osteotomy technique. This technique allows effective bone cutting without the usual thermal tissue damage. Study Design/Materials and Methods A comparative in vivo study on mandibles of seven canines was done with a mechanical saw and a CO2 laser based osteotome with a pulse duration of 80 microseconds. The laser incisions were performed in a multipass mode using a PC-controlled galvanic beam scanner and an assisting water spray. Results A complete healing through a whole bony rearrangement of the Osteotomy gap with newly build lamellar Haversian bone was observed 22 days after the laser operations under optimal irradiation conditions. Conclusions An effective CO2 laser Osteotomy without aggravating thermal side effects and healing delay is possible using the described irradiation technique. It allows an arbitrary cut geometry and may result in new advantageous bone surgery procedures. Lasers Surg. Med. 37:144–148, 2005. © 2005 Wiley-Liss, Inc.
Heikki Leppanen - One of the best experts on this subject based on the ideXlab platform.
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iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty
Journal of Cranio-maxillofacial Surgery, 2000Co-Authors: H Eufinger, Heikki LeppanenAbstract:Abstract Donor site morbidity after bone harvesting still remains a crucial problem in alveolar cleft osteoplasty. This study focuses on ilium donor site morbidity comparing two different techniques. A series of 52 consecutive patients was divided in half. All had anterior iliac crest bone grafts. In the study group the harvesting was performed with a closed Osteotomy using a cylindrical Shepard osteotome. The control group underwent the traditional open Osteotomy. In the open Osteotomy group the short-term morbidity at the donor site was slightly greater than in the closed harvesting group. The low short-term morbidity in the closed harvesting group was reflected in the analgesic consumption which was three times higher in the open Osteotomy group ( p p p Based on these findings we suggest that bone harvesting from the anterior iliac crest remains the preferred method, provided that closed harvesting is undertaken.
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iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty
Journal of Cranio-maxillofacial Surgery, 2000Co-Authors: H Eufinger, Heikki LeppanenAbstract:Donor site morbidity after bone harvesting still remains a crucial problem in alveolar cleft osteoplasty. This study focuses on ilium donor site morbidity comparing two different techniques. A series of 52 consecutive patients was divided in half. All had anterior iliac crest bone grafts. In the study group the harvesting was performed with a closed Osteotomy using a cylindrical Shepard osteotome. The control group underwent the traditional open Osteotomy. In the open Osteotomy group the short-term morbidity at the donor site was slightly greater than in the closed harvesting group. The low short-term morbidity in the closed harvesting group was reflected in the analgesic consumption which was three times higher in the open Osteotomy group (p < 0.008). The most striking difference occurred in the appearance of the mature scar: a length of 24.2 mm (mean) in the closed harvesting group against 60.3 mm in the open Osteotomy group (p < 0.0001), and a width of 4.9 mm (mean) versus 7.7 mm, respectively (p < 0.003). The long-term morbidity was negligible in both groups. Based on these findings we suggest that bone harvesting from the anterior iliac crest remains the preferred method, provided that closed harvesting is undertaken.
Daniel Holzinger - One of the best experts on this subject based on the ideXlab platform.
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cold ablation robot guided laser osteotome carlo from bench to bedside
Journal of Clinical Medicine, 2021Co-Authors: Matthias Ureel, Marcello Augello, Hans-florian Zeilhofer, Philipp Juergens, Daniel Holzinger, Tobias Wilken, Gabriele Millesi, Brittisabelle Berg, Andreas A MuellerAbstract: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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first in man application of a cold ablation robot guided laser osteotome in midface osteotomies
Journal of Cranio-maxillofacial Surgery, 2021Co-Authors: Daniel Holzinger, Matthias Ureel, Tobias Wilken, Andreas Albert Muller, Kurt Schicho, Gabriele Millesi, Philipp JuergensAbstract:Abstract Objective The aim of the study was to assess the clinical applicability of robot guided laser Osteotomy for clinical application. Material and Methods 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 assesd by unimpaired postoperative healing and the absence of device related injuries; performance was assesd as ability to cut the maxilla along the preoperatively planned cutting path with a rage of accuracy of 2mm. Results 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 minutes (±5.3min). Conclusion 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.
Philippe C. Cattin - One of the best experts on this subject based on the ideXlab platform.
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comparing the bone healing after cold ablation robot guided er yag laser Osteotomy and piezoelectric Osteotomy a pilot study in a minipig mandible
Lasers in Surgery and Medicine, 2020Co-Authors: Kyungwon Baek, Philippe C. Cattin, Hans-florian Zeilhofer, Philipp Juergens, Michel DardAbstract:Background and objective To take major advantage of erbium-doped yttrium aluminium garnet (Er:YAG) lasers in Osteotomy-like freedom of cutting geometries and high accuracy-the integration and miniaturization of the robot, laser, and navigation technology was tried and applied to minipigs. The investigators hypothesized laser Osteotomy would render acceptable bone healing based on the intraoperative findings and postoperative cut surface analysis. Study design/materials and methods We designed and implemented a comparative bone-cutting surgery in the minipig mandible with a cold ablation robot-guided Er:YAG laser osteotome (CARLO) and a piezoelectric (PZE) osteotome. The sample was composed of different patterns of defects in the mandibles of six grown-up female Goettingen minipigs. The predictor variable was Er:YAG Osteotomy and PZE Osteotomy. The outcome variable was the cut surface characteristics and bone healing at 4 and 8 weeks postoperatively. Descriptive and qualitative comparison was executed. Results The sample was composed of four kinds of bone defects on both sides of the mandibles of six minipigs. We observed more bleeding during the operation, open-cut surfaces, and a faster healing pattern with the laser Osteotomy. There was a possible association between the intraoperative findings, postoperative cut surface analysis, and the bone healing pattern. Conclusions The results of this study suggest that characteristic open-cut surfaces could explain favorable bone healing after laser Osteotomy. Future studies will focus on the quantification of the early healing characteristics after laser Osteotomy, its diverse application, and the safety feature. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Performing partial mandibular resection, fibula free flap reconstruction and midfacial osteotomies with a cold ablation and robot-guided Er:YAG laser osteotome (CARLO®) – A study on applicability and effectiveness in human cadavers
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2018Co-Authors: Marcello Augello, Philippe C. Cattin, Cyrill Baetscher, Mireille Segesser, Hans-florian Zeilhofer, Philipp JuergensAbstract:Abstract Objective Aim of the study was to prove the safety, accuracy characteristics of contact-free laser Osteotomy executed with the cold ablation and robot-guided Er:YAG laser osteotome in a human cadaver test. Material and methods On six human cadavers mandible resections with a swallowtail like pattern were performed with the laser system on each side. The defects were reconstructed with a fibula graft of identical design and enlarged by 0.2 units. Mandibles and fibulas width as well surgery times were recorded. Additionally a Le Fort I and median mandible split were done. Macroscopically, the bone margins were examined for necrosis. Results Laser osteotomies of the mandible up to a depth of 23 mm were possible without any thermal damage. Repeatability and precision of the system could be easily assessed. With the navigation system precise control of localization was achievable. Mean surgery time for the mandible resection was 13.32 min and for the fibula Osteotomy 12.38 min. Conclusion The simply transmission of a cold ablation and robot-guided laser osteotome in an operation room identical environment for surgical interventions could be demonstrated. Precise Osteotomy patterns with freedom in the design and carbonisation-free cut surfaces have been shown.
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Respiratory motion compensation for the robot-guided laser osteotome
International Journal of Computer Assisted Radiology and Surgery, 2017Co-Authors: Alina Giger, Christoph Jud, Philippe C. CattinAbstract:PurposeThe use of a robot-guided laser osteotome for median sternotomy is impeded by prohibiting cutting inaccuracies due to respiration-induced motions of the thorax. With this paper, we advance today’s methodologies in sternotomy procedures by introducing the concept of novel 3D functional cuts and a respiratory motion compensation algorithm for the computer-assisted and robot-guided laser osteotome, CARLO^®.MethodsWe present a trajectory planning algorithm for performing 3D functional cuts at a constant cutting velocity. In addition, we propose the use of Gaussian process (GP) prediction in order to anticipate the sternum’s pose providing enough time for the CARLO^® device to adjust the position of the laser source.ResultsWe analysed the performance of the proposed algorithms on a computer-based simulation framework of the CARLO^® device. The median position error of the laser focal point has shown to be reduced from 0.22 mm without GP prediction to 0.19 mm with GP prediction.ConclusionThe encouraging simulation results support the proposed respiratory motion compensation algorithm for robot-guided laser Osteotomy on the thorax. Successful compensation of the respiration-induced motion of the thorax opens doors for robot-guided laser sternotomy and the related novel cutting patterns. These functional cuts hold great potential to significantly improve postoperative sternal stability and therefore reduce pain and recovery time for the patient. By enabling functional cuts, we approach an important threshold moment in the history of Osteotomy, creating innovative opportunities which reach far beyond the classic linear cutting patterns.
