We propose to apply image-guided parallel robotic technology to create a robot to assist surgeons with acoustic neuroma surgery, improving both the safety and efficacy of demanding acoustic neuroma removal procedures, which require extraordinary precision. This surgical procedure can benefit from the use of a robotic tool because (1) the accuracy of the drill trajectory is of paramount importance for both safety and efficacy, (vital structures lie in close proximity to the bone that must be removed) and (2) it involves rigid anatomy with vital structures encased in bone which does not deform during surgical intervention. Our hypothesis is more rapid, safer, and more accurate access to vital inner-ear structures can be achieved by combining image-guided surgical techniques and miniature parallel robots directly attached to the bone. The clinical innovation in our work comes from the fact that acoustic neuroma surgery has never before benefited from robotic assistance and current surgical robots are not capable of achieving it due to their size and/or lack of abilit to be accurately registered to the patient. Technical innovation comes from the fact that acoustic neuroma surgery requires the smallest, lightest robot that can achieve its challenging accuracy, force, speed, and workspace requirements. Simultaneous optimization of all these factors requires innovation in robot technology, design, and control theory. To achieve this we propose three specific aims.
Aim 1 addresses the design our proposed acoustic neuroma surgery robot (ANSR). We will determine design parameters for optimal performance in terms of biomechanical forces, torques, and speeds for surgical drill, and then construct the ANSR robot and associated image-guided surgical system.
In Aim 2 we will plan the surgical path and control the robotic system while implementing multiple redundant measures to ensure patient safety. We will apply established registration techniques and create new software that generates a patient-specific motion plan which avoids vital structures and minimizes surgery time, thereby reducing risk to patients. To ensure patient safety, we will the will include throttling, tracking occlusion prevention, emergency stops, drill force monitoring, redundant sensing, and nerve monitoring. Lastly, in Aim 3 we will perform experimental validation studies in phantoms, ex vivo animal bones, and human cadavers using the complete robot system. At the conclusion of this R01, we will have mature hardware and software platforms and will have collected sufficient phantom, animal, and cadaver data to move to human studies through the Food and Drug Administration's Investigational Device Exemption process.

Public Health Relevance

Acoustic neuroma removal can be accomplished more accurately, rapidly, and safely, by combining image-guided surgical techniques and miniature bone-mounted robots to augment the surgeon's judgment and skill. This represents a shift away from the current manual procedures which fundamentally rely on aggressive drilling of bone for several hours, followed by several hours of fine dissection with small, delicate motions to remove cancer in close proximity to vital nerves. The robot will allow the surgeon to devote his or her skills and energy to the portion of the surgery that requires it most, automating the initia drilling phase which distracts from fine dissection and tires the surgeon, while ensuring the safety of vital bone-embedded structures during drilling.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
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Bioengineering, Technology and Surgical Sciences Study Section (BTSS)
Program Officer
Platt, Christopher
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Vanderbilt University Medical Center
Schools of Medicine
United States
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McBrayer, Kepra L; Wanna, George B; Dawant, Benoit M et al. (2017) Resection planning for robotic acoustic neuroma surgery. J Med Imaging (Bellingham) 4:025002
Dillon, Neal P; Fichera, Loris; Kesler, Kyle et al. (2017) Pre-operative Screening and Manual Drilling Strategies to Reduce the Risk of Thermal Injury During Minimally Invasive Cochlear Implantation Surgery. Ann Biomed Eng 45:2184-2195
Siebold, Michael A; Dillon, Neal P; Fichera, Loris et al. (2017) Safety margins in robotic bone milling: from registration uncertainty to statistically safe surgeries. Int J Med Robot 13:
Kratchman, Louis B; Bruns, Trevor L; Abbott, Jake J et al. (2017) Guiding Elastic Rods With a Robot-Manipulated Magnet for Medical Applications. IEEE Trans Robot 33:227-233
Dillon, Neal P; Balachandran, Ramya; Siebold, Michael A et al. (2017) Cadaveric Testing of Robot-Assisted Access to the Internal Auditory Canal for Vestibular Schwannoma Removal. Otol Neurotol 38:441-447
Fichera, Loris; Dillon, Neal P; Zhang, Dongqing et al. (2017) Through the Eustachian Tube and Beyond: A New Miniature Robotic Endoscope to See Into The Middle Ear. IEEE Robot Autom Lett 2:1488-1494
Dillon, Neal P; Fichera, Loris; Wellborn, Patrick S et al. (2016) Making Robots Mill Bone More Like Human Surgeons: Using Bone Density and Anatomic Information to Mill Safely and Efficiently. Rep U S 2016:1837-1843
Dillon, Neal P; Balachandran, Ramya; Labadie, Robert F (2016) Accuracy of linear drilling in temporal bone using drill press system for minimally invasive cochlear implantation. Int J Comput Assist Radiol Surg 11:483-93
Dillon, Neal P; Siebold, Michael A; Mitchell, Jason E et al. (2016) Increasing Safety of a Robotic System for Inner Ear Surgery Using Probabilistic Error Modeling Near Vital Anatomy. Proc SPIE Int Soc Opt Eng 9786:
Dillon, Neal P; Balachandran, Ramya; Fitzpatrick, J Michael et al. (2015) A Compact, Bone-Attached Robot for Mastoidectomy. J Med Device 9:0310031-310037

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