Robotic guided waterjet cutting technique for high tibial dome osteotomy: A pilot study

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS
Eduardo M SueroEmmanouil Liodakis

Abstract

Oscillating saws generate high levels of heat (up to 150°C), which can lead to tissue necrosis, delayed healing and infection. Abrasive waterjet-cutting techniques have been described as a new tool to perform bone cuts, with less heat generation. Four lower-limbs of four human alcohol conserved cadavers were tested. Navigation references were attached to the tibia and an intraoperative fluoroscopy-based 3D scan was obtained. A 1.2 mm diameter nozzle was attached to a robotic arm, which was guided to follow a pre-specified path. In addition, a self-designed jet-absorber was applied to protect the posterior neurovascular structures. Magnesium was added as an abrasive substance to improve the cutting ability of the waterjet. In all four cadavers, the osteotomies could be carried out as planned, resulting in smooth cut surfaces. No damage to the soft-tissues was observed. The advantages of abrasive waterjet-cutting give it great potential in orthopaedic surgery. A current disadvantage is the amount of magnesium solute that is left on the surgical field and can be harmful to the patient.

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