Trepanation of the skull is a common procedure in craniofacial and neurosurgical interventions, allowing access to the innermost cranial structures. Despite a careful advancement, injury of the dura mater represents a frequent complication during these cranial openings. The technology of computer-assisted surgery offers different support systems such as navigated tools and surgical robots. This article presents a novel technical approach toward an image- and sensor-based synergistic control of the cutting depth of a manually guided soft-tissue-preserving saw. Feasibility studies in a laboratory setup modeling relevant skull tissue parameters demonstrate that errors due to computed tomography or magnetic resonance image segmentation and registration, optical tracking, and mechanical tolerances of up to 2.5 mm, imminent to many computer-assisted surgery systems, can be compensated for by the cutting tool characteristics without damaging the dura. In conclusion, the feasibility of a computer-controlled trepanation system providing a safer and efficient trepanation has been demonstrated. Injuries of the dura mater can be avoided, and the bone cutting gap can be reduced to 0.5 mm with potential benefits for the reintegration of the bone flap.

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Machining process is set-up in the machines at different levels of maturity. While in large batch manufacturing, a long time is spent in process design and optimization, and in small batch production, the process design time is limited, and the designed process is far to be optimized. In any case, the possibility to control and optimize the process at machine level is very important to increase the productivity. The concept of cyber-physical systems (CPS) is introduced in this paper to increase machine tool performance and process productivity. Several CPS-based features developed in Twin-Control are presented.

The previous chapters of this book have presented the different features developed in Twin-Control project, including results obtained in research environment. However, M. Armendia (B) IK4-Tekniker,

Re-Sternotomy is an important part of many interventions in cardiac or thoracic surgery. It is performed close to critical structures such as the ascending aorta or the heart with an inherent high risk of serious damage. In this paper, a system for improving the safety of this surgical procedure is presented. A soft tissue preserving saw is combined with automatic depth regulation. The depth is controlled on the basis of the optical characteristics (visible light) of the tissue aligned to the saw blade, which is analyzed using a color sensor. Detection of the blades' position in the bone during the cutting process is possible through the integration of an optical fiber into the tip of the saw blade. The automatic depth control is realized using a hysteresis controller running on a real time system. To show the feasibility of this approach, the sensor technology was integrated into a prototypal sternal saw and evaluated on artificial bone. As part of the experiments the influence of water for cooling and dust particles from the process on the systems control stability were analyzed. The system performed stable and accurate. Future research will focus on the control algorithm and cadaver trials.