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

Autor: Ureel M; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland., Augello M; Cranio Facial Centre, Hirslanden Medical Center, 5000 Aarau, Switzerland., Holzinger D; Department of Oral and Maxillofacial Surgery, Medical University of Vienna, 1090 Vienna, Austria., Wilken T; Advanced Osteotomy Tools AG (AOT), 4051 Basel, Switzerland., Berg BI; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland., Zeilhofer HF; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland., Millesi G; Department of Oral and Maxillofacial Surgery, Medical University of Vienna, 1090 Vienna, Austria., Juergens P; MKG Arabellapark, Private Clinic for Oral & Maxillofacial Surgery, 81925 München, Germany., Mueller AA; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2021 Jan 24; Vol. 10 (3). Date of Electronic Publication: 2021 Jan 24.
DOI: 10.3390/jcm10030450
Abstrakt: Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO ® ).
Methods: The CARLO ® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO ® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO ® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images.
Results: The CARLO ® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications.
Conclusion: The newly developed stand-alone CARLO ® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO ® device with gold-standard surgery protocols will help to define the role of the CARLO ® device in the surgical landscape.
Databáze: MEDLINE
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