title: Design of a bone-attached parallel robot for percutaneous cochlear implantation.
abstract: Access to the cochlea requires drilling in close proximity to bone-embedded nerves, blood vessels, and other structures, the violation of which can result in complications for the patient. It has recently been shown that microstereotactic frames can enable an image-guided percutaneous approach, removing reliance on human experience and hand-eye coordination, and reducing trauma. However, constructing current microstereotactic frames disrupts the clinical workflow, requiring multiday intrasurgical manufacturing delays, or an on-call machine shop in or near the hospital. In this paper, we describe a new kind of microsterotactic frame that obviates these delay and infrastructure issues by being repositionable. Inspired by the prior success of bone-attached parallel robots in knee and spinal procedures, we present an automated image-guided microstereotactic frame. Experiments demonstrate a mean accuracy at the cochlea of 0.20 ± 0.07 mm in phantom testing with trajectories taken from a human clinical dataset. We also describe a cadaver experiment evaluating the entire image-guided surgery pipeline, where we achieved an accuracy of 0.38 mm at the cochlea.
authors.affiliation: Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA. lou.kratchman@vanderbilt.edu
authors.forename: Louis B
authors.initials: LB
authors.lastname: Kratchman
authors.forename: Grégoire S
authors.initials: GS
authors.lastname: Blachon
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Withrow
authors.forename: Ramya
authors.initials: R
authors.lastname: Balachandran
authors.forename: Robert F
authors.initials: RF
authors.lastname: Labadie
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Webster
mesh_terms: D003051:Cochlea / Q000601:surgery*; D019929:Cochlear Implantation / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D006801:Humans; D019047:Phantoms, Imaging; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013701:Temporal Bone / Q000601:surgery*; D014057:Tomography, X-Ray Computed