Alfredo E. Bruno

A comparative investigation of bone surface after cutting with mechanical tools and Er:YAG laser.

Despite of the long history of medical application, laser ablation of bone tissue became successful only recently. Laser bone cutting is proven to have higher accuracy and to increase bone healing compared to conventional mechanical bone cutting. But the reason of subsequent better healing is not biologically explained yet. In this study we present our experience with an integrated miniaturized laser system mounted on a surgical lightweight robotic arm.

Clinical applicability of robot-guided contact-free laser osteotomy in cranio-maxillo-facial surgery: in-vitro simulation and in-vivo surgery in minipig mandibles

Laser was being used in medicine soon after its invention. However, it has been possible to excise hard tissue with lasers only recently, and the Er:YAG laser is now established in the treatment of damaged teeth. Recently experimental studies have investigated its use in bone surgery, where its major advantages are freedom of cutting geometry and precision. However, these advantages become apparent only when the system is used with robotic guidance. The main challenge is ergonomic integration of the laser and the robot, otherwise the surgeons space in the operating theatre is obstructed during the procedure. Here we present our first experiences with an integrated, miniaturised laser system guided by a surgical robot. An Er:YAG laser source and the corresponding optical system were integrated into a composite casing that was mounted on a surgical robotic arm. The robot-guided laser system was connected to a computer-assisted preoperative planning and intraoperative navigation system, and the laser osteotome was used in an operating theatre to create defects of different shapes in the mandibles of 6 minipigs. Similar defects were created on the opposite side with a piezoelectric (PZE) osteotome and a conventional drill guided by a surgeon. The performance was analysed from the points of view of the workflow, ergonomics, ease of use, and safety features. The integrated robot-guided laser osteotome can be ergonomically used in the operating theatre. The computer-assisted and robot-guided laser osteotome is likely to be suitable for clinical use for ostectomies that require considerable accuracy and individual shape.

A compact, efficient, and lightweight laser head for CARLO: integration, performance, and benefits

Ever since the first functional lasers were built about 50 years ago, researchers and doctors dream of a medical use for such systems. Today’s technology is finally advanced enough to realize these ambitions in a variety of medical fields. There are well-established laser based systems in ophthalmology, dental applications, treatment of kidney stones, and many more. Using lasers presents more than just an alternative to conventional methods for osteotomies. It offers less tissue damage, faster healing times, comparable intervention duration and in consequence improves postoperative treatment of patients. However, there are a few factors that limit routine applications. These technical drawbacks include missing depth control and safe guiding of the laser beam. This paper presents the engineering and integration of a miniaturized laser head for a computer assisted and robot-guided laser osteotome (CARLO®), which can overcome the mentioned drawbacks. The CARLO® device ensures a safe and precise guidance of the laser beam. Such guidance also enables new opportunities and methods, e.g. free geometrical functional cuts, which have the potential to revolutionize bone surgery. The laser head is optimized for beam shaping, target conditioning, working distance, compactness and the integration of all other parts needed, e.g. CCD-cameras for monitoring and referencing, a visible laser for cut simulation, etc. The beam coming out of the laser system is conditioned in shape, energy properties and working distance with an optical arrangement to achieve the desired cutting performance. Here also parameters like optical losses, operating mode, optics materials and long-term stability have are taken into account.