Human-Robot Shared Control for Osteotomy Procedure.

Abstract

Spinal intervention can benefit from advancements in robotic systems, particularly in the field of Human-Robot Interaction (HRI). Despite the promising potential of these technologies, their integration into spine surgeries remains relatively limited, comprising mainly only selected procedures. Meanwhile, complex and time-consuming procedures, such as osteotomy, continue to be performed manually, significantly impacting surgeon workload and stress. This paper introduces a robotic system to assist surgeons during the drilling of the vertebral body. The system aims to reduce surgeon workload, enhance surgical precision, and ultimately contribute to improved patient outcomes in spinal surgeries. The system integrates a pre-planning tool for establishing the desired angle of correction, a virtual fixture-based impedance control algorithm enabling the robot to assist the user in following pre-defined cutting trajectories while safeguarding surrounding structures, and a navigation tool for enhanced guidance during the procedure. The proposed system is composed by a 7 Degree-of-Freedom robotic manipulator equipped with a drilling system attached to its end-effector. System accuracy was validated on 5 vertebral phantoms, achieving a tracking error of mm and mm, a margin error of mm and mm, and an angular alignment error of and for the sagittal and coronal planes, respectively.Additionally, the system's performance was evaluated with real porcine bone, with results demonstrating similar precision and robustness under realistic mechanical properties. A user Study was conducted to evaluate whether the proposed system effectively enhanced user performance and alleviated the users' workload compared to a manual control strategy. The results demonstrated reduced deviation from the desired path (Trajectory Error) and fewer instances of the system exceeding predetermined restricted areas (Boundary Violation) when using the proposed system. Additionally, participants rated the proposed system as less mentally and physically demanding in comparison to the traditional control strategy.