Robot-Assisted Craniotomy

Abstract

In the Special Research Centre 414 of the German Research Funding (DFG, Bonn) a system for robot-assisted cranial surgery was developed. It is designed for the accurate and safe execution of craniotomies and repositioning of bone pieces. The system is intended for use in the surgical therapy of craniosynostosis. Preoperatively, CT imaging is performed. In a computerized planning system the position and shape of the intended craniotomy is intuitively planned on a virtual model of the patient's skull. Intraoperatively, after conventional removal of the covering soft tissue, the robot performs the craniotomy autonomously. Extensive testing in phantom studies and animal tests confirmed the reliability and accuracy of the system. A thorough risk analysis of the system was performed. In this paper, the first clinical use of the system on a patient is described and the clinical importance is discussed.

Craniosynostosis - robot-assisted surgery - craniotomy - image-guided surgery

References

• 1 Korb W, Marmulla R, Raczkowsky J, Mühling J, Hassfeld S. Robots in the operating theatre - chances and challenges.  Int J Oral Maxillofac Surg. 2004;  33 721-732
• 2 Kwoh Y S, Hou J, Jonckheere E, Hayati S. A robot with improved absolute positioning accuracy for CT guided stereotactic surgery.  IEEE Trans Biomed Eng. 1998;  35 153-161
• 3 Li Q H, Zamorano L, Pandya A, Perez R, Gong J, Diaz F. The application accuracy of the NeuroMate robot - a quantitative comparison with frameless and frame-based surgical localization systems.  Comput Aided Surg. 2002;  7 90-98
• 4 Morgan P S, Carter T, Davis S, Sepehri A, Punt J, Byrne P, Moody A, Finlay P. The application accuracy of the Pathfinder neurosurgical robot. In: Lemke HD, Vannier MW, Inamura K, Farman AG, Doi K, Reiber JHC (eds). Proceedings of the 17th International Congress and Exhibition “Computer Assisted Radiology and Surgery (CARS)”, June 25 - 28. 2003: 561-567
• 5 Cleary K, Stoianovici D, Patriciu A, Mazilu D, Lindisch D, Watson V. Robotically assisted nerve and facet blocks: a cadaveric study.  Acad Radiol. 2002;  9 821-825
• 6 Stoianovici D. Robotic surgery.  World J Urol. 2000;  18 289-295
• 7 Kronreif G, Fürst M, Kettenbach J, Figl M, Birkfellner W, Hanel R. Interactive localisator for percutaneous interventions. In: Lemke HD, Vannier MW, Inamura K, Farman AG, Doi K, Reiber JHC (eds). Proceedings of the 17th International Congress and Exhibition “Computer Assisted Radiology and Surgery (CARS)”, June 25 - 28. 2003: 498-503
• 8 Schauer D, Hein A, Liith T C. RoboPoint - an autoclavable interactive miniature robot for surgery and interventional radiology. In: Lemke HD, Vannier MW, Inamura K, Farman AG, Doi K, Reiber JHC (eds). Proceedings of the 17th International Congress and Exhibition “Computer Assisted Radiology and Surgery (CARS)”, June 25 - 28. 2003: 555-560
• 9 Finlay P A, Ornstein M H. Controlling the movement of a surgical laparoscope.  IEEE Eng Med Biol. 1995;  14 289-291
• 10 Sackier J M, Wang Y. Robotically assisted laparoscopic surgery: From concept to development. In: Taylor RH, Lavallee S, Burdea GC, Mosges R (eds). Computer Integrated Surgery. Cambridge, Mass: MIT Press 1996 45: 577-580
• 11 Taylor R H, Mittelstadt B D, Paul H A, Hanson W, Kazanzides P, Zuhars J F, Williamson B, Musits B L, Glassman E, Bargar W L. An image-directed robotic system for precise orthopeaedic surgery. In: Taylor RH, Lavallee S, Burdea GC, Mosges R (eds). Computer Integrated Surgery. Cambridge, Mass: MIT Press 1996 28: 379-396
• 12 Taylor R H, Joskowicz L, Williamson B, Gueziec A, Kalvin A, Kazanzides P, Vorhis R van, Yao J, Kumar R, Bzostek A, Sahay A, Bomer M, Lahmer A. Computer-integrated revision total hip replacement surgery: concept and preliminary results.  Med Image Anal. 1999;  3 301-319
• 13 Korb W, Engel D, Boesecke R, Eggers G, Kotrikova B, Marmulla R, Raczkowsky J, Wörn H, Mühling J, Hassfeld S. Development and first patient trial of a surgical robot for complex trajectory milling.  Comput Aided Surg. 2003;  8 247-256
• 14 Brief J, Hassfeld S, Haag C, Münchenberg J, Schorr O, Däuber S, Engel D, Krempien R, Treiber M, Wörn H, Mühling J. Clinical evaluation of an operation planning system in the field of cranio-maxillo-facial surgery. In: Lemke HU, Vannier MW, Inamura K, Farman AG, Doi K (eds). Computer Assisted Radiology and Surgery. Proceedings of the 15th International Symposium and Exhibition on Computer Assisted Radiology and Surgery. CARS 2001 Berlin, June 27 - 30; 2001: 1230-1231
• 15 Schorr O, Brief J, Haag C, Raczkowsky J, Hassfeld S, Mühling J, Wörn H. Operationsplanung in der Kopfchirurgie.  Biomed Tech (Berl). 2002;  47 (Suppl 1 Pt 2) 939-941
• 16 Lorensen W E, Cline H E. Marching cubes: A high resolution 3D surface construction algorithm. International Conference on Computer Graphics and Interactive Techniques: Proceedings of the 14^th annual conference on Computer graphics and interactive techniques. 1987: 163-169
• 17 Sweeney R A, Bale R, Auberger T, Vogele M, Foerster S, Nevinny-Stickel M, Lukas P. A Simple non-invasive vacuum mouthpiece-based head fixation system for high precision radiotherapy.  Strahlenther Onkol. 2001;  177 43-47
• 18 Engel D, Korb W, Raczkowsky J, Hassfeld S, Wörn H. Location decision for a robot milling complex trajectories in craniofacial surgery. In: Lemke HU, Vannier MW, Inamura K, Farman AG, Doi K, Reiber JHC (eds). Proceedings of the 17th International Congress and Exhibition “Computer Assisted Radiology and Surgery (CARS)”, June 25 - 28, 2003: 760-765
• 19 Arun K S, Huang T S, Blodstein S D. Least-squares fitting of two 3-D point sets.  IEEE Trans Pattern Anal Mach Intell. 1987;  9 698-700
• 20 Eggers G, Däuber S, Korb W, Welzel T, Marmulla R, Hassfeld S. Image data acquisition and segmentation for accurate modeling of the calvarium. Medical Imaging 2004: Visualization, Image-Guided Procedures, and Display. In: Galloway RL Jr (ed). Proceedings of SPIE. 2004 5367: 829-836
• 21 Hoppe H, Däuber S, Raczkowsky J, Wörn H, Moctezuma J L. Intraoperative visualization of surgical planning data using video projectors.  Stud Health Technol Inform. 2001;  81 206-208
• 22 Marmulla R, Mühling J, Wirtz C R, Hassfeld S. High-resolution laser surface scanning for patient registration in cranial computer-assisted surgery.  Minim Invas Neurosurg. 2004;  47 72-78
• 23 Fitzpatrick J M, West J B, Maurer Jr C R. Predicting error in rigid-body point-based registration.  IEEE Trans Med Imaging. 1998;  17 694-702
• 24 Korb W, Engel D, Boesecke R, O'Sullivan N, Raczkowsky J, Marmulla R, Hassfeld S. Risk-analysis for a reliable and safe surgical robot. In: Lemke HD, Vannier MW, Inamura K, Farman AG, Doi K, Reiber JHC (eds). Proceedings of the 17th International Congress and Exhibition “Computer Assisted Radiology and Surgery (CARS)”; 2003: 766-770
• 25 Zöller J E, Kübler A C, Lorber W D, Mühling J FH. Kraniofaziale Chirurgie. Stuttgart: Thieme Verlag 2002
• 26 Mühling J, Collmann H, Reuther J, Sorensen N. Functional and anatomic aspects of the orbitotomy in craniofacial surgery.  Neurosurg Rev. 1989;  12 21-23
• 27 Hassfeld S, Mühling J. Computer assisted oral and maxillofacial surgery - a review and an assessment of technology.  Int J Oral Maxillofac Surg. 2001;  30 2-13
• 28 Hassfeld S, Mühling J. Navigation in maxillofacial and craniofacial surgery.  Comput Aided Surg. 1998;  3 183-187