Automatic laser steering for middle ear surgery

TL;DR

This paper presents an automated laser steering system for minimally invasive middle ear surgery, combining macro and micro robotic systems with image-based control to precisely target residual infected tissues.

Contribution

It introduces a novel robotic platform with automated trajectory planning and image-based control for laser surgery inside the middle ear.

Findings

Achieved high accuracy in laser targeting

Validated system effectiveness experimentally

Met clinical requirements for laser surgery

Abstract

This paper deals with the control of laser spot in the context of minimally invasive surgery of the middle ear, e.g., cholesteatoma removal. More precisely, our work is concerned with the exhaustive burring of residual infected cells after primary mechanical resection of the pathological tissues since the latter cannot guarantee the treatment of all the infected tissues, the remaining infected cells cause regeneration of the diseases in 20%-25\-% of cases, which require a second surgery 12-18 months later. To tackle such a complex surgery, we have developed a robotic platform that consists of the combination of a macro-scale system (7 degrees of freedom (DoFs) robotic arm) and a micro-scale flexible system (2 DoFs) which operates inside the middle ear cavity. To be able to treat the residual cholesteatoma regions, we proposed a method to automatically generate optimal laser scanning trajectories inside the regions and between them. The trajectories are tacked using an image-based control scheme. The proposed method and materials were validated experimentally using the lab-made robotic platform. The obtained results in terms of accuracy and behaviour meet perfectly the laser surgery requirements.