A cadaver study of mastoidectomy using an image‐guided human–robot collaborative control system

Abstract

ObjectiveSurgical precision would be better achieved with the development of an anatomical monitoring and controlling robot system than by traditional surgery techniques alone. We evaluated the feasibility of robot‐assisted mastoidectomy in terms of duration, precision, and safety.Study DesignHuman cadaveric study.Materials and MethodsWe developed a multi‐degree‐of‐freedom robot system for a surgical drill with a balancing arm. The drill system is manipulated by the surgeon, the motion of the drill burr is monitored by the image‐guided system, and the brake is controlled by the robotic system. The system also includes an alarm as well as the brake to help avoid unexpected damage to vital structures. Experimental mastoidectomy was performed in 11 temporal bones of six cadavers. Parameters including duration and safety were assessed, as well as intraoperative damage, which was judged via pre‐ and post‐operative computed tomography.ResultsThe duration of mastoidectomy in our study was comparable with that required for chronic otitis media patients. Although minor damage, such as dura exposure without tearing, was noted, no critical damage to the facial nerve or other important structures was observed. When the brake system was set to 1 mm from the facial nerve, the postoperative average bone thicknesses of the facial nerve was 1.39, 1.41, 1.22, 1.41, and 1.55 mm in the lateral, posterior pyramidal and anterior, lateral, and posterior mastoid portions, respectively.ConclusionMastoidectomy can be successfully performed using our robot‐assisted system while maintaining a pre‐set limit of 1 mm in most cases. This system may thus be useful for more inexperienced surgeons.Level of EvidenceNA.

Robotic Cochlear Implant Surgery: Imaging-Based Evaluation of Feasibility in Clinical Routine

“…Recently, minimal invasive surgical techniques have been proposed for middle and inner ear access in order to reduce the extent of the surgical approach such as a direct access to the round window region originating from the surface of the mastoid and without performing a mastoidectomy (6,7). Several studies using cadaveric specimens have proven feasibility of a robot to perform neurotological surgeries (8)(9)(10)(11).…”

Micro/Macro-Scale Robotic Approach for Middle Ear Surgery

“…However, all these solutions are based on rigid tools and do not include any dexterous instrument for intracorporeal fine movement execution. Other works highlight the feasibility of robot-assisted ear surgery such as robotassisted mastoidectomy [6] and tool-guidance [7] which is not sufficient for the cholesteatoma treatment in which surgeons mainly suffer from a lack of dexterity and accuracy in tooltip positioning. The main contributions of this paper are the design of a redundant macro/micro-scale robotic structure with embedded teleoperation interface as well as the development of two control modes for robotic middle ear surgery execution.…”

Robotics in otorhinolaryngology – head and neck surgery

“…101 Other future developments relate to miniaturisation of surgical robots that will further expand their application to paediatric patients with diseases of the head and neck. 18 Finally, autonomous surgical robots are currently been trialed in the laboratory for a variety of high-precision procedures in ORL-HNS including mastoidectomy, 102 cochlear implantation, 103 and the establishment of the translabyrinthine approach to the internal auditory canal to provide access for vestibular schwannoma resection. 104 Those phenomenal technological advances in less than a decade are unprecedented.…”