The study conducted by Ya Li et al. focuses on the efficacy and surgical safety of automated laminectomy robot procedures, particularly investigating how different resection methods impact surgical outcomes. Laminectomy is a common surgical treatment for spinal stenosis, which can lead to severe neurological complications if not addressed. Traditionally, this procedure has been performed using bone forceps and high-speed drills, both of which present risks such as excessive bleeding and damage to surrounding tissues.

Objective
The primary objective of this research is to compare two common lamina resection methods—drilling and layer-by-layer techniques—using an automated laminectomy robot. The research aims to assess the effects of these methods on the robotic system’s performance, particularly concerning surgical safety and precision.

Methods
The study utilized ovine spinal samples to simulate lamina resection surgeries. The analysis focused on measuring force feedback and lateral deviations at the end of the robotic arm during the resection process. The robotic system employed a KUKA LBR iiwa robotic arm equipped with a six-dimensional force sensor and an ultrasonic osteotome, which operates using high-frequency ultrasonic vibrations.

Approval for the study was granted by the Ethics Committee of Beihang University, and the specimens were carefully processed to maintain anatomical integrity while being free of diseases.

Results
The results demonstrated that the drilling method yielded an average peak force of 1.21 N with lateral deviations confined to within 1 mm, while the layer-by-layer method had a peak force of 2.39 N and deviations reaching up to 1.6 mm. This indicates that the drilling method is significantly safer and more precise than the layer-by-layer method.

Both methods were classified as Grade A according to the surgical accuracy grading standards, as the deviations remained within acceptable limits. However, the drilling method exhibited smaller deviations and enhanced intraoperative safety.

Surgical Safety Evaluation
Surgical safety was evaluated using real-time force feedback from the robotic arm’s endpoint. It was observed that excessive lateral forces and speeds could lead to increased lateral displacement, thereby elevating the risks of breaching safety boundaries during surgery. Notably, the integrity of the dura mater was preserved in both resection methods, with no instances of cerebrospinal fluid leakage being reported.

Discussion
The study concludes that the drilling method provides superior precision and safety in automated laminectomy procedures. The reduced risk associated with this method can be attributed to the controlled movement patterns and lower forces exerted during resection, minimizing the likelihood of tissue damage. The effectiveness of the penetration state recognition algorithm was highlighted, as it successfully prevented damage to critical structures during the surgical process.

Limitations and Future Work
While the findings are promising, the study acknowledges limitations, such as the lack of consideration for patient-specific anatomical variations and potential movement from respiration during actual surgeries. Future research will aim to incorporate diverse experimental scenarios, including cadaveric studies and live clinical trials, to further refine robotic safety strategies and enhance reliability in surgical applications.

Conclusion
This research underscores the importance of method selection in robotic spinal surgery. It advocates for the drilling method as the preferred choice for robotic manufacturers in designing automatic laminectomy systems, given its demonstrated efficacy and safety. This work contributes to the evolving field of spinal surgery robotics, emphasizing intraoperative safety and precision as paramount concerns for successful surgical outcomes.

SOURCE:  https://onlinelibrary.wiley.com/doi/full/10.1002/rcs.70031?campaign=woletoc

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