Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
Institute of Mechatronics and Logistics Equipment, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
Comput Methods Programs Biomed. 2024 Jun;249:108156. doi: 10.1016/j.cmpb.2024.108156. Epub 2024 Mar 27.
BACKGROUNDS: Zygomatic implant (ZI) placement surgery is a viable surgical option for patients with severe maxillary atrophy and insufficient residual maxillary bone. Still, it is difficult and risky due to the long path of ZI placement and the narrow field of vision. Dynamic navigation is a superior solution, but it presents challenges such as requiring operators to have advanced skills and experience. Moreover, the precision and stability of manual implantation remain inadequate. These issues are anticipated to be addressed by implementing robot-assisted surgery and achieved by introducing a mixed reality (MR) navigation-guided hybrid robotic system for ZI placement surgery. METHODS: This study utilized a hybrid robotic system to perform the ZI placement surgery. Our first step was to reconstruct a virtual 3D model from preoperative cone-beam CT (CBCT) images. We proposed a series of algorithms based on coordinate transformation, which includes image-phantom registration, HoloLens-tracker registration, drill-phantom calibration, and robot-implant calibration, to unify all objects within the same coordinate system. These algorithms enable real-time tracking of the surgical drill's position and orientation relative to the patient phantom. Subsequently, the surgical drill is directed to the entry position, and the planned implantation paths are superimposed on the patient phantom using HoloLens 2 for visualization. Finally, the hybrid robot system performs the processed of drilling, expansion, and placement of ZIs under the guidance of the MR navigation system. RESULTS: Phantom experiments of ZI placement were conducted using 10 patient phantoms, with a total of 40 ZIs inserted. Out of these, 20 were manually implanted, and the remaining 20 were robotically implanted. Comparisons between the actual implanted ZI paths and the preoperatively planned ZI paths showed that our MR navigation-guided hybrid robotic system achieved a coronal deviation of 0.887 ± 0.213 mm, an apical deviation of 1.201 ± 0.318 mm, and an angular deviation of 3.468 ± 0.339° This demonstrates significantly better accuracy and stability than manual implantation. CONCLUSION: Our proposed hybrid robotic system enables automated ZI placement surgery guided by MR navigation, achieving greater accuracy and stability compared to manual operations in phantom experiments. Furthermore, this system is expected to apply to animal and cadaveric experiments, to get a good ready for clinical studies.
背景：颧骨种植体（ZI）植入术是一种可行的手术选择，适用于严重上颌萎缩和上颌骨残余骨量不足的患者。然而，由于 ZI 植入的路径较长，视野较窄，手术难度大且风险高。动态导航是一种较好的解决方案，但它也存在一些挑战，例如需要操作人员具备先进的技能和经验。此外，手动植入的精度和稳定性仍不够理想。这些问题预计可以通过实施机器人辅助手术来解决，并通过引入一种混合现实（MR）导航引导的混合机器人系统来实现 ZI 植入手术。
方法：本研究使用混合机器人系统进行 ZI 植入手术。我们的第一步是从术前锥形束 CT（CBCT）图像重建一个虚拟的 3D 模型。我们提出了一系列基于坐标变换的算法，包括图像-模型配准、HoloLens-跟踪器配准、钻头-模型校准和机器人-植入物校准，以将所有物体统一到同一坐标系中。这些算法能够实时跟踪手术钻头相对于患者模型的位置和方向。随后，将手术钻头引导至入口位置，并使用 HoloLens 2 将计划的植入路径叠加在患者模型上进行可视化。最后，混合机器人系统在 MR 导航系统的指导下完成 ZI 的钻孔、扩张和植入处理。
结果：使用 10 个患者模型进行了 ZI 植入的体模实验，总共植入了 40 个 ZI。其中 20 个是手动植入的，其余 20 个是机器人植入的。实际植入的 ZI 路径与术前计划的 ZI 路径的比较结果表明，我们的 MR 导航引导的混合机器人系统实现了冠状方向的偏差为 0.887±0.213mm，根尖方向的偏差为 1.201±0.318mm，角度方向的偏差为 3.468±0.339°。这表明与手动植入相比，该系统具有更好的准确性和稳定性。
结论：我们提出的混合机器人系统能够实现 MR 导航引导的自动化 ZI 植入手术，在体模实验中比手动操作具有更高的准确性和稳定性。此外，该系统有望应用于动物和尸体实验，为临床研究做好充分准备。
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