Dillon Neal P, Balachandran Ramya, Siebold Michael A, Webster Robert J, Wanna George B, Labadie Robert F
*Mechanical Engineering †Otolaryngology, Vanderbilt University Medical Center ‡Electrical Engineering, Vanderbilt University, Nashville, Tennessee.
Otol Neurotol. 2017 Mar;38(3):441-447. doi: 10.1097/MAO.0000000000001324.
An image-guided robotic system can safely perform the bulk removal of bone during the translabyrinthine approach to vestibular schwannoma (VS).
The translabyrinthine approach to VS removal involves extensive manual milling in the temporal bone to gain access to the internal auditory canal (IAC) for tumor resection. This bone removal is time consuming and challenging due to the presence of vital anatomy (e.g., facial nerve) embedded within the temporal bone. A robotic system can use preoperative imaging and segmentations to guide a surgical drill to remove a prescribed volume of bone, thereby preserving the surgeon for the more delicate work of opening the IAC and resecting the tumor.
Fresh human cadaver heads were used in the experiments. For each trial, the desired bone resection volume was planned on a preoperative computed tomography (CT) image, the steps in the proposed clinical workflow were undertaken, and the robot was programmed to mill the specified volume. A postoperative CT scan was acquired for evaluation of the accuracy of the milled cavity and examination of vital anatomy.
In all experimental trials, the facial nerve and chorda tympani were preserved. The root mean squared surface accuracy of the milled cavities ranged from 0.23 to 0.65 mm and the milling time ranged from 32.7 to 57.0 minute.
This work shows feasibility of using a robot-assisted approach for VS removal surgery. Further testing and system improvements are necessary to enable clinical translation of this technology.
在经迷路入路切除前庭神经鞘瘤（VS）的过程中，图像引导的机器人系统能够安全地进行大块骨质切除。
经迷路入路切除VS需要在颞骨中进行广泛的手工铣削，以进入内耳道（IAC）进行肿瘤切除。由于颞骨内存在重要解剖结构（如面神经），这种骨质切除既耗时又具有挑战性。机器人系统可以利用术前成像和分割来引导手术钻头切除规定体积的骨质，从而使外科医生能够专注于打开IAC和切除肿瘤等更精细的工作。
实验使用新鲜人类尸体头部。对于每次试验，在术前计算机断层扫描（CT）图像上规划所需的骨质切除体积，按照拟议的临床工作流程进行步骤操作，并对机器人进行编程以铣削指定体积的骨质。术后进行CT扫描，以评估铣削腔的准确性并检查重要解剖结构。
在所有实验性试验中，面神经和鼓索均得以保留。铣削腔的均方根表面精度范围为0.23至0.65毫米，铣削时间范围为32.7至57.0分钟。
这项工作表明了使用机器人辅助方法进行VS切除手术的可行性。要使该技术能够应用于临床，还需要进一步测试和改进系统。
