Navigation-Robotics

The main project areas are:

  • Computer and robot assisted systems for knee surgery;
  • Development and clinical validation of minimally invasive surgical navigation systems for knee surgery;
  • Robotic systems and devices.

Computer and robot assisted systems for knee surgery

The main goal in computer assisted surgery is to improve the accuracy, quality, safety and predictability of surgical interventions by exploiting hi-tech devices and by designing new surgical equipment and methodologies for better and better outcomes.
Our work includes the investigation of basic numerical procedures, biomedical data processing and modelling, design, validation and test of new devices for improved surgical treatment and the development of assisted techniques, using automatic systems, navigation systems or semiautomatic approaches.
The computer and robot  assisted protocol for total knee arthroplasty (see the document Robot assisted TKR) is historically the most important subject our lab has worked on.

The system includes three main  phases which have been optimized in specific studies: computer assisted planning (see the document Planning), intraoperative registration (see the document Registration) and computer assisted execution.
Later a simpler and less expensive computer assisted system based on intraoperative fluoroscopic images was developed for tibia osteotomy (see the document Osteotomy), enabling the surgeon to plan and track the intervention on a 3D view of the limb obtained from calibrated pairs of fluoroscopic scans (see the images below).

 

Computer planning of tibia osteotomy

 

During last year we have developed the prototype of a computer assisted technique for TKA Revision. It is based on the use of a new navigation system, RTKANav. The system doesn't use any patient model derived from pre-operative medical images, but the patient anatomy model is represented by landmarks acquired intra-operatively and axes computed from them. These data describe the main anatomical features on the software interface and provide the surgeon with the main references for the intervention (see the image below).

 

Navigated intervention of knee prosthesis revision

 

The system is always able to suggest an intervention plan, even if during the acquisition phase some specific points can not be identified because a set of redundant criteria to choose each degree of freedom is implemented for each prosthetic component. The system provides the surgeon with tools to analyze and modify the proposed plan, and to reproduce it on the patient. A more detailed description can be found in (see the document Navigated revision TKA).

Development and clinical validation of minimally invasive surgical navigation systems for knee surgery

In general, minimally invasive surgery in orthopaedics can offer a lot of benefits to the patient in comparison with conventional approach: shorter incisions, less pain in rehabilitation, less disruption of normal anatomic structures, and consequently less trauma to the surrounding tissue, and shorter hospitalization. Software for the minimally invasive implant of unicompartmental DePuy knee prosthesisAt the same time, it has some drawbacks, due to the reduced visibility of many of the joint structures and of some landmarks.
Navigation systems can solve these visibility problems by allowing a virtual reproduction of a model of the patient anatomy on the system interface together with some of the surgical instruments in use during the intervention and with some numerical data related to the main parameters of the intervention.
Our lab worked on the development and clinical validation of a navigation system for minimally invasive unicompartmental knee arthroplasty in collaboration with DePuy International (see the image aside).

In short a clinical trial concerning minimally invasive total knee replacement will start, to compare the minimally invasive manual technique with minimally invasive navigated technique, developed using Ci' System, DePuy.

 

Robotic systems and devices

The first surgical procedure assisted a robotic system was developed for percutaneous discectomy. This procedure used a commercial robot with a safe modified control to insert the  surgical tools on the target disk under fluoroscopic control (see the document Discectomy). Active robotic system for orthopaedic surgeryThe use of a commercial robot showed several limitations and therefore we designed a new ergonomic and intrinsically safe robot with application oriented end-effectors for a  wide range of orthopaedic surgical procedures (such as total knee replacement) (see the document Robot for surgical applications).

At present we are working on a passive robotic arm  to realize surgical actions with the same precision of active or semi-active robotic systems and without the problems connected with the use of  this device (see the document Robotic arm system). Concerning surgical devices, some sensorized prototypes were developed for different applications and some of them have been clinically tested (see the document Sensor Tensor and the document Devices).

Content updated 14/10/2010 - 09:58
Content edited by: Dott. Andrea Paltrinieri (redazioneweb@ior.it)
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