Robotic drilling was conducted with an accuracy of 0.2 mm and safety mechanisms predicted proximity of the nerves to within 0.1 mm. The approach resulted in a minimal mastoidectomy and minimal incisions. Manual electrode array insertion was successfully performed through the robotically drilled tunnel. The procedure was performed without complications, and all surrounding structures were preserved.

Surgical robot systems can work beyond the limits of human perception, dexterity and scale making them inherently suitable for use in microsurgical procedures. However, despite extensive research, image-guided robotics applications for microsurgery have seen limited introduction into clinical care to date. Among others, challenges are geometric scale and haptic resolution at which the surgeon cannot sufficiently control a device outside the range of human faculties. Mechanisms are required to ascertain redundant control on process variables that ensure safety of the device, much like instrument-flight in avionics. Cochlear implantation surgery is a microsurgical procedure, in which specific tasks are at sub-millimetric scale and exceed reliable visuo-tactile feedback. Cochlear implantation is subject to intra- and inter-operative variations, leading to potentially inconsistent clinical and audiological outcomes for patients. The concept of robotic cochlear implantation aims to increase consistency of surgical outcomes such as preservation of residual hearing and reduce invasiveness of the procedure. We report successful image-guided, robotic CI in human. The robotic treatment model encompasses: computer-assisted surgery planning, precision stereotactic image-guidance, in-situ assessment of tissue properties and multipolar neuromonitoring (NM), all based on in vitro, in vivo and pilot data. The model is expandable to integrate additional robotic functionalities such as cochlear access and electrode insertion. Our results demonstrate the feasibility and possibilities of using robotic technology for microsurgery on the lateral skull base. It has the potential for benefit in other microsurgical domains for which there is no task-oriented, robotic technology available at present.

Surgical robots have been proposed ex vivo to drill precise holes in the temporal bone for minimally invasive cochlear implantation. The main risk of the procedure is damage of the facial nerve due to mechanical interaction or due to temperature elevation during the drilling process.To evaluate the thermal risk of the drilling process, a simplified model is proposed which aims to enable an assessment of risk posed to the facial nerve for a given set of constant process parameters for different mastoid bone densities. The model uses the bone density distribution along the drilling trajectory in the mastoid bone to calculate a time dependent heat production function at the tip of the drill bit. Using a time dependent moving point source Green's function, the heat equation can be solved at a certain point in space so that the resulting temperatures can be calculated over time. The model was calibrated and initially verified with in vivo temperature data. The data was collected in minimally invasive robotic drilling of 12 holes in four different sheep. The sheep were anesthetized and the temperature elevations were measured with a thermocouple which was inserted in a previously drilled hole next to the planned drilling trajectory. Bone density distributions were extracted from pre-operative CT data by averaging Hounsfield values over the drill bit diameter. Post-operative µCT data was used to verify the drilling accuracy of the trajectories. The comparison of measured and calculated temperatures shows a very good match for both heating and cooling phases. The average prediction error of the maximum temperature was less than 0.7°C and the average root mean square error was approximately 0.5°C. To analyze potential thermal damage, the model was used to calculate temperature profiles and cumulative equivalent minutes at 43°C at a minimal distance to the facial nerve. For the selected drilling parameters, temperature elevation profiles and cumulative equivalent minutes suggest that thermal elevation of this minimally invasive cochlear implantation surgery may pose a risk to the facial nerve, especially in sclerotic or high density mastoid bones. Optimized drilling parameters need to be evaluated and the model could be used for future risk evaluation.

This research work aims at reducing temperature elevation of bone drilling. An extensive experimental study was conducted which focused on the investigation of three main measures to reduce the temperature elevation as used in industry: irrigation, interval drilling and drill bit designs. Different external irrigation rates (0 ml/min, 15 ml/min, 30 ml/min), continuously drilled interval lengths (2 mm, 1 mm, 0.5 mm) as well as two drill bit designs were tested. A custom single flute drill bit was designed with a higher rake angle and smaller chisel edge to generate less heat compared to a standard surgical drill bit. A new experimental setup was developed to measure drilling forces and torques as well as the 2D temperature field at any depth using a high resolution thermal camera. The results show that external irrigation is a main factor to reduce temperature elevation due not primarily to its effect on cooling but rather due to the prevention of drill bit clogging. During drilling, the build up of bone material in the drill bit flutes result in excessive temperatures due to an increase in thrust forces and torques. Drilling in intervals allows the removal of bone chips and cleaning of flutes when the drill bit is extracted as well as cooling of the bone in-between intervals which limits the accumulation of heat. However, reducing the length of the drilled interval was found only to be beneficial for temperature reduction using the newly designed drill bit due to the improved cutting geometry. To evaluate possible tissue damage caused by the generated heat increase, cumulative equivalent minutes (CEM43) were calculated and it was found that the combination of small interval length (0.5 mm), high irrigation rate (30 ml/min) and the newly designed drill bit was the only parameter combination which allowed drilling below the time-thermal threshold for tissue damage. In conclusion, an optimized drilling method has been found which might also enable drilling in more delicate procedures such as that performed during minimally invasive robotic cochlear implantation.

Surgical interventions close to vulnerable structures, such as nerves, require precise handling of surgical instruments and tools. These tools not only pose the risk of mechanical damage to soft tissues, but they also generate heat, which can lead to thermal necrosis of bone or soft tissues. Researchers and engineers are trying to improve those tools through experimentation and simulations. To simulate temperature distributions in anatomical structures, reliable material constants are needed. Therefore, this study aimed at investigating the thermal conductivity of cortical and cancellous bone. Accordingly, a custom-made steady-state experimental setup was designed and validated. 6 bovine and 3 human cortical bone samples, as well as 32 bovine cancellous bone samples, with variable bone volume fraction were tested. The cancellous bone samples were scanned by micro-computed tomography (µCT) and micro-finite element (µFE) voxel models were created to calculate iteratively the thermal conductivity of the bone marrow. The experimental results provided 0.64 ± 0.04 W/ mK for bovine cortical bone and 0.68 ± 0.01 W/mK for human cortical bone. A linear dependency of thermal conductivity on bone volume fraction was found for cancellous bone [R-square (R 2 ) = 0.8096, standard error of the estimates (SEE) = 0.0355 W/mK]. The thermal conductivity of the bone marrow was estimated to be 0.42 ± 0.05 W/mK. These results will help to improve thermal finite element simulations of the human skeleton and aid the development of new surgical tools or procedures.Keywords: Thermal conductivity of compact and trabecular bone, specific heat of bone, thermal bone necrosis, temperature of cutting or drilling of bone.

During surgical procedures, the heat development of bone cutting can lead to thermal cell necrosis and secondary implant instability. Therefore, fundamental knowledge on heat development and temperature control is crucial. This paper investigates the basic principles of the machining of cortical bone in an orthogonal cutting process. Cutting forces, temperature elevation and chip formation were measured in real time for two different rake angles and six different cutting depths. A non-linear relationship between cutting depth and cutting forces as well as temperature elevation was found. A linear correlation between cutting forces and temperature elevation of both bone chip and workpiece was determined (R 2 = 0.8697) An increasing rake angle lowered cutting forces and temperature elevations significantly and was explained using a fracture mechanics approach. Additionally, a new method to calculate the fracture toughness of (quasi-)brittle materials from orthogonal cutting tests was introduced. Recent advances in numerical modeling of bone cutting have been summarized by Marco et al. [15] but there are only limited models for the cutting of brittle or quasi-brittle materials [16].However, compared to metals, cortical bone is a very different material with a quasi-brittle and not ductile behavior. It is anisotropic with osteons (∅ 200 µm)

Cutting and drilling operations in bone are involved in many orthopedic and otolaryngological surgeries. The temperature elevation of these procedures is potentially harmful to bone and soft tissue cells. The research on this topic aims therefore at minimizing temperature elevation and finding optimal process parameters. Experimental studies are mostly carried out on ex vivo setups using bovine bone material. For temperature measurements, either thermocouples or infrared cameras are used. Infrared cameras have potential advantages, but the emissivity value of the material has to be known. Literature values are scattered and vary within a wide range. An experimental study was carried out to quantify the emissivity using freshly frozen bovine and human bone, as well as human bone samples which were either fixed with Formalin or Thiel solution. Additionally, different surface finishes were used and emissivity was evaluated at different temperatures. The mean emissivity of bone was determined to be ɛ=0.96±0.01 for temperature elevations up to 60 °C. A slightly higher value of ɛ=0.97±0.01 was found for temperatures around 80 °C. No significant differences for human or bovine bone samples, preparation or fixation techniques were found.

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