Niesche Annegret, Müller Meiko, Ehreiser Fritz, Teichmann Daniel, Leonhardt Steffen, Radermacher Klaus
1 Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany.
2 Philips Chair for Medical Information Technology, RWTH Aachen University, Aachen, Germany.
Proc Inst Mech Eng H. 2017 Jul;231(7):673-680. doi: 10.1177/0954411917700445. Epub 2017 Apr 7.
Craniotomy is part of many neurosurgical interventions to create surgical access to intracranial structures. The procedure conventionally bears a high risk of unintended dural tears or damage of the soft tissue underneath the bone. A new synergistically controlled instrument has recently been introduced to address this problem by combining a soft tissue preserving saw with an automatic cutting depth control. Many approaches are known to obtain the information required on the local bone thickness. However, they suffer from unsatisfactory robustness against disturbances occurring during surgery and many approaches require additional intra- or preoperative steps in the workflow. This article presents first concepts for real-time cutting depth control based on in-process bioimpedance measurements. Furthermore, sensor integration into a synergistic surgical device incorporating a bidirectional oscillating saw is demonstrated and evaluated in first feasibility tests on a fresh bovine bone specimen. Results of bipolar measurements show that the transition of different layers of bicortical bone and bone breakthrough lead to characteristic impedance patterns that can be used for process control.
开颅手术是许多神经外科手术干预的一部分，用于创建进入颅内结构的手术通道。传统上，该手术存在意外硬脑膜撕裂或骨下软组织损伤的高风险。最近引入了一种新的协同控制仪器，通过将软组织保护锯与自动切割深度控制相结合来解决这一问题。已知有许多方法可获取局部骨厚度所需的信息。然而，它们在手术过程中对干扰的鲁棒性不令人满意，并且许多方法在工作流程中需要额外的术中或术前步骤。本文介绍了基于术中生物阻抗测量的实时切割深度控制的初步概念。此外，在新鲜牛骨标本上的首次可行性测试中，展示并评估了将传感器集成到包含双向振荡锯的协同手术设备中。双极测量结果表明，双皮质骨不同层的转变和骨穿透会导致可用于过程控制的特征阻抗模式。
