Cold Ablation Robot-Guided Laser Osteotome (CARLO^®): From Bench to Bedside

Area of Science:

• Minimally Invasive Surgery
• Robotic Surgery
• Laser-Assisted Surgery

Background:

• Conventional osteotomy instruments face geometrical and physical limitations.
• Digital surgical planning presents challenges in operating room translation.
• A novel robot-guided laser system, CARLO®, was developed to address these limitations.

Purpose of the Study:

• To present the first-in-man clinical experience with the CARLO® system.
• To evaluate the feasibility and accuracy of robot-guided laser osteotomy in orthognathic surgery.

Main Methods:

• Utilized a 2.94-µm Er:YAG laser mounted on a robotic arm (CARLO®).
• Performed a linear Le Fort I midface osteotomy in a 19-year-old patient.
• Digitally planned osteotomy transferred to the CARLO® system for autonomous execution under visual control.

Main Results:

• The CARLO® device successfully completed the linear osteotomy without technical or safety issues.
• Achieved high accuracy with a maximum deviation of 0.8 mm and RMS error of 1.0 mm compared to the digital plan.
• The patient experienced normal postoperative healing without complications.

Conclusions:

• The CARLO® device offers a potential alternative to conventional osteotomy tools.
• Improvements needed in target marker fixation and active depth control for enhanced workflow.
• Further research on safety, accuracy, and cost-effectiveness is required to define its surgical role.