Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside

Abstract

Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®). Methods: The CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. Results: The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. Conclusion: The newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape.

Cold ablation robot‐guided laser osteotomy in hand, wrist and forearm surgery—A feasibility study

“…The safety and efficacy of CARLO ® was confirmed in 2019 during first‐in‐man clinical study (ClinicalTrials.gov Identifier: NCT03901209), without intraoperative complications or technical failure and was granted CE‐1250 certification in 2021 17,20 …”

“…The safety and efficacy of CARLO ® was confirmed in 2019 during first-in-man clinical study (ClinicalTrials.gov Identifier: NCT03901209), without intraoperative complications or technical failure and was granted CE-1250 certification in 2021. 17,20 The navigated and controlled free movement of the robotic arm allows for changing of directions during the osteotomy process. This freedom reveals new possibilities for combined cutting patterns which are impossible to precisely cut in manually fashion.…”

Laser ablation for precision 3D bone shaping: beyond channel cuts

“…Laser ablation of biological tissues is not new, with widespread use in ophthalmology, urology and dentistry [16][17][18] . Laser osteotomy, the removal of bone via laser ablation, has more recently seen adoption in maxillofacial surgery 19 . Infrared laser sources, in particular Er:YAG lasers emitting at 2.94 µm, a wavelength heavily absorbed by water, have proved to be very effective at bone ablation [20][21][22] .…”

“…Previous applications of laser osteotomy have primarily focused on drilling or cutting fine channels 19,24,25 . This research has aimed to highlight the potential for lasers to perform the same task as a mechanical cutting tool.…”

Three-dimensional imaging of porcine joints down to the subcellular level

“…It is reasonable to expect that in near future robot-guided lasers will be successfully employed to excavate damaged cartilage from joints. The present study aimed at the selection of an appropriate imaging method and the examination of a potential sample preparation protocol for investigating lesions generated by CARLO ® (Cold Ablation Robot-assisted Laser Osteotome, Advanced Osteotomy Tools AG, Basel, Switzerland) [1], which is one of the world's first digital, orthopedic laser surgery platforms. The system is equipped with a 2940-nm Er:YAG laser targeting the water content in the tissue.…”