Development and validation of collaborative robot-assisted cutting method for iliac crest flap raising: Randomized crossover trial

Scientific Reports, vol. 15, pp. 16909

Abstract

The current gold standard of computer-assisted jaw reconstruction includes raising microvascular bone flaps with patient-specific 3D-printed cutting guides. The downsides of cutting guides are invasive fixation, periosteal denudation, preoperative lead time and missing intraoperative flexibility. This study aimed to investigate the feasibility and accuracy of a robot-assisted cutting method for raising iliac crest flaps compared to a conventional 3D-printed cutting guide. In a randomized crossover design, 40 participants raised flaps on pelvic models using conventional cutting guides and a robot-assisted cutting method. The accuracy was measured and compared regarding osteotomy angle deviation, Hausdorff Distance (HD) and Average Hausdorff Distance (AVD). Duration, workload and usability were further evaluated. The mean angular deviation for the robot-assisted cutting method was 1.9 ± 1.1° (mean ± sd) and for the 3D-printed cutting guide it was 4.7 ± 2.9° (p < 0.001). The HD resulted in a mean value of 1.5 ± 0.6 mm (robot) and 2.0 ± 0.9 mm (conventional) (p < 0.001). For the AVD, this was 0.8 ± 0.5 mm (robot) and 0.8 ± 0.4 mm (conventional) (p = 0.320). Collaborative robot-assisted cutting is an alternative to 3D-printed cutting guides in experimental static settings, achieving slot design benefits with less invasiveness and higher intraoperative flexibility. In the next step, the results should be tested in a dynamic environment with a moving phantom and on the cadaver.

Authors 10

1. Yao Li Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

2. Sergey Drobinsky Aachen Chair of Medical Engineering

   RWTH Aachen University

   Affiliation as printed

   Chair of Medical Engineering, RWTH Aachen University, 52074, Aachen, Germany

3. Jan Egger

   University of Duisburg-Essen

   Affiliation as printed

   Institute for Artificial Intelligence in Medicine, University of Duisburg-Essen, 45131, Essen, Germany

4. Kunpeng Xie Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

5. Ashkan Rashad Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

6. Klaus Radermacher Aachen Chair of Medical Engineering

   RWTH Aachen University

   Affiliation as printed

   Chair of Medical Engineering, RWTH Aachen University, 52074, Aachen, Germany

7. Rainer Röhrig Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

8. Matias de la Fuente Aachen Chair of Medical Engineering

   RWTH Aachen University

   Affiliation as printed

   Chair of Medical Engineering, RWTH Aachen University, 52074, Aachen, Germany

9. Frank Hölzle Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

10. Behrus Puladi corresponding Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. bpuladi@ukaachen.de

    Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. bpuladi@ukaachen.de