The introduction of Er:YAG lasers for soft and hard tissue ablation has proven promising results over the last decades due to strong absorption at 2.94 μm wavelength by water molecules. An extension to endoluminal applications demands laser delivery without mirror arms due to dimensional constraints. Therefore, fiber-based solutions are advanced to provide exible access while keeping space requirements to a minimum. Conventional fiber-based treatments aim at laser-tissue interactions in contact mode. However, this procedure is associated with disadvantages such as advancing decrease in power delivery due to particle coverage of the fiber tip, tissue carbonization, and obstructed observation of the ablation progress. The objective of this work is to overcome aforementioned limitations with a customized fiber-based module for non-contact robot-assisted endoluminal surgery and its associated experimental evaluation. Up to the authors knowledge, this approach has not been presented in the context of laser surgery at 2.94 μm wavelength. The preliminary system design is composed of a 3D Er:YAG laser processing unit enabling automatic laser to fiber coupling, a GeO<sub>2</sub> solid core fiber, and a customized module combining collimation and focusing unit (focal length of 20 mm, outer diameter of 8 mm). The performance is evaluated with studies on tissue substitutes (agar-agar) as well as porcine samples that are analysed by optical coherence tomography measurements. Cuts (depths up to 3mm) with minimal carbonization have been achieved under adequate moistening and sample movement (1.5mms<sup>-1</sup>). Furthermore, an early cadaver study is presented. Future work aims at module miniaturization and integration into an endoluminal robot for scanning and focus adaptation.
This work investigates combination of Optical Coherence Tomography and two cameras, observing a microscopic scene. Stereo vision provides realistic images, but is limited in terms of penetration depth. Optical Coherence Tomography (OCT) enables access to subcutaneous structures, but 3D-OCT volume data do not give the surgeon a familiar view. The extension of the stereo camera setup with OCT imaging combines the benefits of both modalities. In order to provide the surgeon with a convenient integration of OCT into the vision interface, we present an automated image processing analysis of OCT and stereo camera data as well as combined imaging as augmented reality visualization. Therefore, we care about OCT image noise, perform segmentation as well as develop proper registration objects and methods. The registration between stereo camera and OCT results in a Root Mean Square error of 284 μm as average of five measurements. The presented methods are fundamental for fusion of both imaging modalities. Augmented reality is shown as application of the results. Further developments lead to fused visualization of subcutaneous structures, as information of OCT images, into stereo vision.
This work proposes new methods for a microstereotactic frame based on bone cement fixation. Microstereotactic frames are under investigation for minimal invasive temporal bone surgery, e.g. cochlear implantation, or for deep brain stimulation, where products are already on the market. The correct pose of the microstereotactic frame is either adjusted outside or inside the operating room and the frame is used for e.g. drill or electrode guidance. We present a patientspecific, disposable frame that allows intraoperative, sterile pose-setting. Key idea of our approach is bone cement between two plates that cures while the plates are positioned with a mechatronics system in the desired pose. This paper includes new designs of microstereotactic frames, a system for alignment and first measurements to analyze accuracy and applicable load.
Recent research has revealed that incision planning in laser surgery deploying stylus and tablet outperforms state-of-the-art micro-manipulator-based laser control. Providing more detailed quantitation regarding that approach, a comparative study of six tablet-based strategies for laser path planning is presented. Reference strategy is defined by monoscopic visualization and continuous path drawing on a graphics tablet. Further concepts deploying stereoscopic or a synthesized laser view, point-based path definition, real-time teleoperation or a pen display are compared with the reference scenario. Volunteers were asked to redraw and ablate stamped lines on a sample. Performance is assessed by measuring planning accuracy, completion time and ease of use. Results demonstrate that significant differences exist between proposed concepts. The reference strategy provides more accurate incision planning than the stereo or laser view scenario. Real-time teleoperation performs best with respect to completion time without indicating any significant deviation in accuracy and usability. Point-based planning as well as the pen display provide most accurate planning and increased ease of use compared to the reference strategy. As a result, combining the pen display approach with point-based planning has potential to become a powerful strategy because of benefiting from improved hand-eye-coordination on the one hand and from a simple but accurate technique for path definition on the other hand. These findings as well as the overall usability scale indicating high acceptance and consistence of proposed strategies motivate further advanced tablet-based planning in laser microsurgery.