Sun Mengzhe, Lin Li, Chen Xiaojun, Xu Cheng, Zin Mar Aung, Han Wenqing, Chai Gang
Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China.
Ann Transl Med. 2021 Apr;9(7):567. doi: 10.21037/atm-20-6305.
To explore the potential of electromagnetic (EM) navigation technology in the field of robot-assisted surgery, we set up a maxillofacial surgical robotic system (MSRS) guided by an EM navigation tool. Mandibular angle osteotomy was used to analyze the feasibility in confined surgical areas.
Model and animal experiments were implemented to validate the system precision. Before the experiment, a customized dental splint was made and then fixed with a standard navigation part. An accurate 3D surgical plan was designed based on the preoperative CT scan. During the experiment, the splint was rigidly mounted on teeth for navigation registration, so the robot could position a specially designed template to guide the accurate osteotomy according to the preoperative plan. For the model experiment, a Coordinate Measuring Machine was used to measure the template's position and angle. For the animal experiment, surgeons completed the surgery by moving a saw along the template, while a postoperative CT scan was carried out to calculate the precision.
All procedures were successfully completed, with no complications in any of the experimental animals. In the model experiment, the accuracy of the navigation position and angle was 0.44±0.19 mm and 3.5°±2.1°, respectively. In the animal experiment, the lateral osteotomy line error was 0.83±0.62 mm, the interior error was 1.06±1.03 mm, and the angle between the actual cutting plane and preoperative planning plane was 5.9°±4.7°.
Robot-assisted surgery with EM navigation resulted feasible in the real operating environment. Moreover, this system's precision could meet clinical needs, while the proposed procedure was safe and easy on animals. Consequently, this approach has the potential to be applied to clinical craniomaxillofacial practice in the near future.
为探索电磁（EM）导航技术在机器人辅助手术领域的潜力，我们建立了一个由EM导航工具引导的颌面外科机器人系统（MSRS）。采用下颌角截骨术分析在受限手术区域的可行性。
进行模型和动物实验以验证系统精度。实验前，制作定制的牙夹板，然后用标准导航部件固定。基于术前CT扫描设计精确的三维手术方案。实验过程中，将夹板牢固地安装在牙齿上进行导航注册，使机器人能够定位专门设计的模板，根据术前方案引导精确截骨。对于模型实验，使用坐标测量机测量模板的位置和角度。对于动物实验，外科医生沿模板移动锯完成手术，同时进行术后CT扫描以计算精度。
所有手术均成功完成，实验动物均无并发症。在模型实验中，导航位置和角度的精度分别为0.44±0.19毫米和3.5°±2.1°。在动物实验中，外侧截骨线误差为0.83±0.62毫米，内侧误差为1.06±1.03毫米，实际切割平面与术前规划平面的夹角为5.9°±4.7°。
电磁导航机器人辅助手术在实际手术环境中是可行的。此外，该系统的精度能够满足临床需求，且所提出的手术方法对动物安全且操作简便。因此，这种方法在不久的将来有可能应用于临床颅颌面手术。
