Robot assisted laser bone ablation has the potential to revolutionize surgery, especially in those interventions where the accuracy achievable manually is not sufficient.

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Purpose Laser ablation of hard tissue is not completely understood until now and not modeled for computer-assisted microsurgery. A precise planning and simulation is an essential step toward the usage of microsurgical laser bone ablation in the operating room. Methods Planning the volume for laser bone ablation is based on geometrical definitions. Shape and volume of the removed bone by single laser pulses were measured with a confocal microscope for modeling the microsurgical ablation. To remove the planned volume and to achieve smooth surfaces, a simulation of the laser pulse distribution is developed.A talk and a proceedings contribution with the German title Planung und Simulation von mikrochirurgischer Laserknochenablation [1] was presented at curac.08 in Leipzig, Germany. ResultsThe confocal measurements show a clear dependency from laser energy and resulting depth. Twodimensional Gaussian functions are fitting in these craters. Exemplarily three ablation layers were planned, simulated, executed and verified. Conclusions To model laser bone ablation in microsurgery the volume and shape of each laser pulse should be known and considered in the process of ablation planning and simulation.

Objective: Today's surgical robots normally perform "simple" trajectories, e.g., assisting as tool-holding devices in neurosurgery, or milling linear paths for cavities in total hip replacement. From a clinical point of view, it is still a complex undertaking to implement robots in the operating room. Until now, robot systems have not been used in patient trials to mill "complex" trajectories, which involve many positional and orientation changes and are often necessary in cranio-mdofacial (CMF) surgery. This paper presents the RobaCKa surgical robot system, which allows more precise execution of surgical interventions and milling of "complex" trajectories.Materials and Methods: The main components of the RobaCKa system are a (former) CASPAR robot system, a POLARIS system, and a force-torque sensor.Results: In the first patient trial (April 2003) the planned mjectory was executed with an error of 0.66 2 0.2 mm.Conclusions: The use of former industrial robots for surgical applications is possible but complex. The advantages are improved precision and quality and the possibility of documentation. The use of such systems is normally limited to research institutions or large clinics, because it is hardly possible to implement the necessary technical and logistic efforts in routine surgical work. Comp A d Surg 8:247-256 (2003). 02003 CAS Journal, LLC

In the Special Research Centre 414 of the German Research Funding (DFG, Bonn) a system for robot-assisted cranial surgery was developed. It is designed for the accurate and safe execution of craniotomies and repositioning of bone pieces. The system is intended for use in the surgical therapy of craniosynostosis. Preoperatively, CT imaging is performed. In a computerized planning system the position and shape of the intended craniotomy is intuitively planned on a virtual model of the patient's skull. Intraoperatively, after conventional removal of the covering soft tissue, the robot performs the craniotomy autonomously. Extensive testing in phantom studies and animal tests confirmed the reliability and accuracy of the system. A thorough risk analysis of the system was performed. In this paper, the first clinical use of the system on a patient is described and the clinical importance is discussed.