Optical coherence tomography guided laser cochleostomy: towards the accuracy on tens of micrometer scale

Lasers have been proven to be precise tools for bone ablation. Applying no mechanical stress to the patient, they are potentially very suitable for microsurgery on fragile structures such as the inner ear. However, it remains challenging to control the laser-bone ablation without injuring embedded soft tissue. In this work, we demonstrate a closed-loop control of a short-pulsed CO2 laser to perform laser cochleostomy under the monitoring of an optical coherence tomography (OCT) system. A foresighted detection of the bone-endosteum-perilymph boundary several hundred micrometers before its exposure has been realized. Position and duration of the laser pulses are planned based on the residual bone thickness distribution. OCT itself is also used as a highly accurate tracking system for motion compensation between the target area and the optics. During ex vivo experimental evaluation on fresh porcine cochleae, the ablation process terminated automatically when the thickness of the residual tissue layer uniformly reached a predefined value. The shape of the resulting channel bottom converged to the natural curvature of the endosteal layer without injuring the critical structure. Preliminary measurements in OCT scans indicated that the mean absolute accuracy of the shape approximation was only around 20 μm

On-line motion planning for medical applications

Enhancing the quality of surgical interventions is one of the main goals of surgical robotics. Thus we have devised a surgical robotic system for maxillofacial surgery which can be used as an intelligent intraoperative surgical tool. Up to now a surgeon preoperatively plans an intervention by studying twodimensional X-rays, thus neglecting the third dimension. In course of the special research programme "Computer and Sensor Aided Surgery" a planning system has been developed at our institute, which allows the surgeon to plan an operation on a threedimensional computer model of the patient . Transposing the preoperatively planned bone cuts, bore holes, cavities, and milled surfaces during surgery still proves to be a problem, as no adequate means are at hand: the actual performance of the surgical intervention and the surgical outcome solely depend on the experience and the skill of the operating surgeon. In this paper we present our approach of a surgical robotic system to be used in maxillofacial surgery. Special stress is being laid upon the modelling of the environment in the operating theatre and the motion planning of our surgical robot