Toward Robotic Craniosynostosis Surgery: Development of a Novel Articulated Minimally Invasive Bone Cutting Tool

Craniosynostosis involves premature fusion of the cranial sutures resulting in an abnormal head shape and functional sequelae such as raised intracranial pressure [1]. Surgery is required and can be performed open or endoscopically. Both approaches require osteotomies to either remove the fused suture or to remodel the bone. The endoscopic approach is performed using smaller incisions and has reduced blood loss, operative time and cost in comparison to the open approach [2]. However, with the endoscopic approach, the osteotomy extent is limited due to reduced access using currently available surgical tools [3]. As a result, the patient is required to wear a molding helmet post-operatively and only certain types of craniosynostosis can be treated using this approach. Conventional instruments for craniosynostosis surgery consists of straight rigid tools. They are simple and intuitive to manipulate with open accessibility, but are difficult to use in restricted areas. Furthermore, the unique curvature of the skull limits the reach of the instruments during craniosynostosis surgery. A novel steerable instrument would allow performance of extensive osteotomies on the skull using key-hole incisions. Such a device would eliminate the need for a molding helmet and can be used to treat all types of craniosynostosis. The following paper describes a novel articulating bone cutting device specifically designed for keyhole craniosynostosis surgery that can also be utilized for any procedure requiring a craniotomy. This device would represent a paradigm shift in minimal access cranial surgery.