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@PHDTHESIS{Niesche:991823,
author = {Niesche, Annegret},
othercontributors = {Radermacher, Klaus and Corves, Burkhard},
title = {{H}andgehaltener {M}iniaturroboter für die orthopädische
{C}hirurgie},
volume = {76},
school = {RWTH Aachen University},
type = {Dissertation},
address = {Düren},
publisher = {Shaker Verlag},
reportid = {RWTH-2024-07914},
series = {Aachener Beiträge zur Medizintechnik},
pages = {1 Online-Ressource : Illustrationen},
year = {2024},
note = {Druckausgabe: 2024. - Auch veröffentlicht auf dem
Publikationsserver der RWTH Aachen University; Dissertation,
RWTH Aachen University, 2024},
abstract = {Numerous assistance systems have been developed to support
the surgeon in effective and efficient bone machining with
minimally invasive access. One possibility of interaction is
the principle of synergistic control. It enables the robotic
assistance system to control and optimize individual target
variables while actively involving the operator into the
process. However, current approaches show disadvantages with
regard to flexible integration into the surgical work
environment and workflow, require invasive bone fixation or
offer only limited possibilities for process optimization.
This thesis investigates the approach of using a synergistic
hand-held active robot for bone machining. After manual
coarse positioning, the robot executes the fine movement of
the instrument for bone machining, thereby compensating for
undesired human movements. By manually repositioning the
robot, the accessible working space is expanded. The system
itself therefore can be designed with a smaller working
space and occupies less space in the operating room compared
to robots which are installed at a fixed position in the
room. A successful demonstration of this approach on a hard
material like cortical bone is not known so far. In order to
enable the compensation for the human reaction movements
caused by the process forces as well as involuntary tremor
and drift movements, the investigated approach was extended
using a mechanical support of the robot for stabilization.
The proposed approach has been investigated for milling the
implant seat in minimally invasive unicondylar knee
arthroplasty (UKA), i.e. for the fabrication of a
three-dimensional free-form surface on the bone. A
functional prototype of the robot, held by the operator with
both hands and with a weight of 2.5 kg, was realized. In
addition, repositioning strategies for use with a mechanical
support unit were presented. In milling tests on bone
substitute material, a deviation ranging from 0.32 mm to
0.99 mm (RMSE) of a machined surface from the planned
surface was achieved. This is within the deviation of 0.67
mm (RMSE, σ = 0.37 mm) achieved with the commercial,
visually guided NAVIO system for UKA surgery, which does not
allow for automated and thus systematic control of the bone
machining parameters (e.g. milling tool path, depth, feed
rate). In addition, the applicability of the hand-held robot
was demonstrated in a UKA surgery on a human cadaver. A
deviation between -0.7 mm and 0.6 mm of the machined bone
surface from the planned surface was achieved with a bone
machining time of 5 minutes for the tibial and 10 minutes
for the femoral condyle. Again, values comparable to the
NAVIO system were achieved. To sum up, milling bone using a
hand-held, active robot with a mechanical support is
possible with the accuracy and efficiency of a commercial
system for UKA, but with the advantage of an automated and
thus systematic implementation of optimal milling
parameters.},
cin = {419410},
ddc = {620},
cid = {$I:(DE-82)419410_20140620$},
typ = {PUB:(DE-HGF)11 / PUB:(DE-HGF)3},
doi = {10.18154/RWTH-2024-07914},
url = {https://publications.rwth-aachen.de/record/991823},
}
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