Haworth Jesse, Sahu Manish, Zhu Katherine, Hammond Jacob, Ishida Hisashi, Munawar Adnan, Yang Robin, Taylor Russell
Department of Mechanical Engineering, Johns Hopkins University, Baltimore, USA.
Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, USA.
Int J Comput Assist Radiol Surg. 2025 Jul;20(7):1307-1314. doi: 10.1007/s11548-025-03403-3. Epub 2025 May 21.
Precise osteotomies are vital in maxillofacial procedures such as the bilateral sagittal split osteotomy (BSSO) where surgical accuracy and precision directly impacts patient outcomes. Conventional freehand drilling can lead to unfavorable splits, negatively impacting surgical outcome.
This paper presents the development work of a cooperatively controlled robot system designed to enhance the efficacy of osteotomies during BSSO. The system features two assistive modes for the execution of a patient-specific surgical plan: (1) a Haptic guidance mode that helps the surgeon align the surgical drill with the planned cutting plane to improve surgical accuracy of the cut and (2) an Active constraint mode that restricts deviations from the cutting plane to enhance surgical precision during drilling. We validated the system through feasibility experiments involving 36 mandible phantoms and a cadaveric specimen, with a surgeon, a surgical resident, and a medical student performing osteotomies freehand and with robotic assistance. Additionally, NASA TLX surveys were conducted to assess the perceived ease of use of the robotic system.
Compared to freehand methods, the robotic system improved the efficacy of the cut from to mm for the med student, to mm for the resident, and to mm for the surgeon while reducing the task load.
Our experimental results demonstrate that the proposed robotic system can enhance the precision of surgical drilling in the BSSO compared to a freehand approach. These findings indicate the potential of robotic systems to reduce errors and enhance patient outcomes in maxillofacial surgery.
精确截骨术在诸如双侧矢状劈开截骨术（BSSO）等颌面手术中至关重要，手术的准确性和精确性直接影响患者的治疗效果。传统的徒手钻孔可能导致不理想的劈开，对手术结果产生负面影响。
本文介绍了一种协同控制机器人系统的研发工作，该系统旨在提高BSSO手术中截骨术的效果。该系统具有两种辅助模式来执行针对特定患者的手术计划：（1）触觉引导模式，帮助外科医生将手术钻头与计划的切割平面对齐，以提高切割的手术准确性；（2）主动约束模式，限制偏离切割平面，以提高钻孔过程中的手术精度。我们通过涉及36个下颌骨模型和一个尸体标本的可行性实验对该系统进行了验证，由一名外科医生、一名外科住院医师和一名医学生分别徒手以及在机器人辅助下进行截骨术。此外，还进行了NASA TLX调查，以评估对机器人系统易用性的感知。
与徒手方法相比，机器人系统提高了医学生的切割效果，从[具体数值1]毫米提高到[具体数值2]毫米，住院医师从[具体数值3]毫米提高到[具体数值4]毫米，外科医生从[具体数值5]毫米提高到[具体数值6]毫米，同时减轻了任务负荷。
我们的实验结果表明，与徒手方法相比，所提出的机器人系统可以提高BSSO手术钻孔的精度。这些发现表明机器人系统在减少颌面手术中的误差和改善患者治疗效果方面具有潜力。
