CIGuide：原位增强现实激光引导。

PURPOSE : A robotic intraoperative laser guidance system with hybrid optic-magnetic tracking for skull base surgery is presented. It provides in situ augmented reality guidance for microscopic interventions at the lateral skull base with minimal mental and workload overhead on surgeons working without a monitor and dedicated pointing tools. METHODS : Three components were developed: a registration tool (Rhinospider), a hybrid magneto-optic-tracked robotic feedback control scheme and a modified robotic end-effector. Rhinospider optimizes registration of patient and preoperative CT data by excluding user errors in fiducial localization with magnetic tracking. The hybrid controller uses an integrated microscope HD camera for robotic control with a guidance beam shining on a dual plate setup avoiding magnetic field distortions. A robotic needle insertion platform (iSYS Medizintechnik GmbH, Austria) was modified to position a laser beam with high precision in a surgical scene compatible to microscopic surgery. RESULTS : System accuracy was evaluated quantitatively at various target positions on a phantom. The accuracy found is 1.2 mm ± 0.5 mm. Errors are primarily due to magnetic tracking. This application accuracy seems suitable for most surgical procedures in the lateral skull base. The system was evaluated quantitatively during a mastoidectomy of an anatomic head specimen and was judged useful by the surgeon. CONCLUSION : A hybrid robotic laser guidance system with direct visual feedback is proposed for navigated drilling and intraoperative structure localization. The system provides visual cues directly on/in the patient anatomy, reducing the standard limitations of AR visualizations like depth perception. The custom- built end-effector for the iSYS robot is transparent to using surgical microscopes and compatible with magnetic tracking. The cadaver experiment showed that guidance was accurate and that the end-effector is unobtrusive. This laser guidance has potential to aid the surgeon in finding the optimal mastoidectomy trajectory in more difficult interventions.

目的：提出了一种用于颅底手术的具有混合光学-磁性跟踪的机器人术中激光引导系统。它为侧颅底的显微镜介入提供了原位增强现实指导，使没有监视器和专用指向工具的外科医生的工作负担最小化。

方法：开发了三个组件：注册工具（Rhinospider）、混合磁光跟踪的机器人反馈控制方案和修改后的机器人末端执行器。Rhinospider 通过在使用磁性跟踪时排除用户在基准定位中的错误，优化了患者和术前 CT 数据的注册。混合控制器使用集成显微镜高清摄像机进行机器人控制，同时引导光束照射在双板设置上，避免磁场失真。对机器人针插入平台（iSYS Medizintechnik GmbH，奥地利）进行了修改，以在兼容显微镜手术的手术场景中高精度地定位激光束。

结果：在幻影中的不同目标位置上对系统精度进行了定量评估。发现的精度为 1.2 毫米±0.5 毫米。误差主要是由于磁性跟踪引起的。这种应用精度似乎适用于大多数侧颅底手术。该系统在解剖头标本的乳突切除术中进行了定量评估，外科医生认为该系统有用。

结论：提出了一种具有直接视觉反馈的混合机器人激光引导系统，用于导航钻孔和术中结构定位。该系统直接在患者解剖结构上提供视觉提示，减少了 AR 可视化的标准限制，如深度感知。为 iSYS 机器人定制的末端执行器对使用手术显微镜是透明的，并且与磁性跟踪兼容。尸体实验表明，该引导系统的准确性高，末端执行器不显眼。这种激光引导有可能帮助外科医生在更困难的手术中找到最佳的乳突切除术轨迹。