A New Template and Teleoperation System for Human-Guided Spine Surgery.

Abstract

Fluoroscopy-guided placement of pedicle screws is usually used to position pedicle screws, although it is highly risky due to lack of accuracy during operation and surgeon's intensive labor requirement during surgery. In this study, a new method was introduced to consider the issues and we tried to reduce the risk of pedicle screw placement and drilling process. To put pedicle screws in the correct position and orientation, a specific drill guide is designed and fabricated by additive manufacturing technology. In addition, since the drilling process is remarkably important and it is usually dependent on surgeon skill, therefore a teleoperation system is proposed to perform this task. In order to let the surgeon to have better control on the patient, a control scheme including position and velocity signals along with surgeon force and reaction force of vertebra was proposed. This helped the surgeon for proper control on the patient during surgery. A force estimation algorithm was presented to eliminate measuring external force signal. Consequently, 10 vertebras were used to evaluate specific drill guide and teleoperation system simultaneously. Then, the computed tomography evaluation demonstrated that Kirschner wire trajectories followed the planned axes with an error between 1 and 2mm in 20% of cases and less than 1 mm in 80% of cases. The results obtained by the teleoperation system showed that the surgeon, in the master side, has proper control over the patient body in the slave side because the slave robot followed the master position. Furthermore, the surgeon in the master side sensed the reaction force of vertebra in the slave side appropriately.