Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology.
Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
J Craniofac Surg. 2020 Nov/Dec;31(8):2324-2328. doi: 10.1097/SCS.0000000000006767.
Orthognathic surgery is an effective method to correct the dentomaxillofacial deformities. The aim of the study is to introduce the robot-assisted orthognathic surgery and demonstrate the accuracy and feasibility of robot-assisted osteotomy in transferring the preoperative virtual surgical planning (VSP) into the intraoperative phase.
The CMF robot system, a craniomaxillofacial surgical robot system was developed, consisted of a robotic arm with 6 degrees of freedom, a self-developed end-effector, and an optical localizer. The individualized end-effector was installed with reciprocating saw so that it could perform osteotomy. The study included control and experimental groups. In control group, under the guidance of navigation system, surgeon performed the osteotomies on 3 skull models. In experimental group, according to the preoperative VSP, the robot completed the osteotomies on 3 skull models automatically with assistance of navigation. Statistical analysis was carried out to evaluate the accuracy and feasibility of robot-assisted orthognathic surgery and compare the errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy.
All the osteotomies were successfully completed. The overall osteotomy error was 1.07 ± 0.19 mm in the control group, and 1.12 ± 0.20 mm in the experimental group. No significant difference in osteotomy errors was found in the robot-assisted osteotomy groups (P = 0.353). There was consistence of errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy.
In robot-assisted orthognathic surgery, the robot can complete an osteotomy according to the preoperative VSP and transfer a preoperative VSP into the actual surgical operation with good accuracy and feasibility.
正颌手术是矫正牙颌面畸形的有效方法。本研究旨在介绍机器人辅助正颌手术，并展示机器人辅助截骨术将术前虚拟手术规划（VSP）转化为术中阶段的准确性和可行性。
CMF 机器人系统，一种颅颌面外科机器人系统，由具有 6 个自由度的机械臂、自主开发的末端执行器和光学定位器组成。个性化末端执行器安装有往复锯，以便进行截骨术。该研究包括对照组和实验组。在对照组中，在导航系统的指导下，外科医生在 3 个颅骨模型上进行截骨术。在实验组中，根据术前 VSP，机器人在导航的辅助下自动完成 3 个颅骨模型的截骨术。进行了统计分析，以评估机器人辅助正颌手术的准确性和可行性，并比较机器人辅助自动截骨术和导航辅助手动截骨术之间的误差。
所有截骨术均成功完成。对照组的整体截骨误差为 1.07±0.19mm，实验组为 1.12±0.20mm。机器人辅助截骨组的截骨误差无显著差异（P=0.353）。机器人辅助自动截骨术和导航辅助手动截骨术的误差具有一致性。
在机器人辅助正颌手术中，机器人可以根据术前 VSP 完成截骨，并以良好的准确性和可行性将术前 VSP 转化为实际手术操作。
