CIGuide: in situ augmented reality laser guidance

Area of Science:

• Neurosurgery
• Robotics
• Medical Imaging

Background:

• Skull base surgery presents challenges in precise navigation.
• Minimally invasive techniques require advanced guidance systems.
• Augmented reality (AR) offers potential but faces limitations like depth perception.

Purpose of the Study:

• To present a robotic intraoperative laser guidance system for skull base surgery.
• To provide in situ AR guidance for microscopic interventions with reduced surgeon workload.
• To enhance surgical precision and safety in lateral skull base procedures.

Main Methods:

• Development of a registration tool (Rhinospider) for accurate patient and CT data registration using magnetic tracking.
• Implementation of a hybrid magneto-optic-tracked robotic feedback control scheme.
• Modification of a robotic needle insertion platform to precisely position a laser beam for microscopic surgery.

Main Results:

• System accuracy evaluated at 1.2 mm ± 0.5 mm on a phantom, primarily limited by magnetic tracking.
• The system demonstrated suitability for lateral skull base surgical procedures.
• Successful quantitative evaluation during a mastoidectomy on an anatomic head specimen, with positive surgeon feedback.

Conclusions:

• A hybrid robotic laser guidance system with direct visual feedback is proposed for navigated drilling and intraoperative localization.
• The system offers direct visual cues on patient anatomy, overcoming AR depth perception limitations.
• The developed system is compatible with surgical microscopes and magnetic tracking, showing potential for complex mastoidectomy trajectories.