Skull base surgery is a demanding field in which surgeons operate in and around the skull while avoiding critical anatomical structures including nerves and vasculature. While image-guided surgical navigation is the prevailing standard, limitation still exists requiring personalized planning and recognizing the irreplaceable role of a skilled surgeon. This paper presents a collaboratively controlled robotic system tailored for assisted drilling in skull base surgery. Our central hypothesis posits that this collaborative system, enriched with haptic assistive modes to enforce virtual fixtures, holds the potential to significantly enhance surgical safety, streamline efficiency, and alleviate the physical demands on the surgeon. The paper describes the intricate system development work required to enable these virtual fixtures through haptic assistive modes. To validate our system's performance and effectiveness, we conducted initial feasibility experiments involving a medical student and two experienced surgeons. The experiment focused on drilling around critical structures following cortical mastoidectomy, utilizing dental stone phantom and cadaveric models. Our experimental results demonstrate that our proposed haptic feedback mechanism enhances the safety of drilling around critical structures compared to systems lacking haptic assistance. With the aid of our system, surgeons were able to safely skeletonize the critical structures without breaching any critical structure even under obstructed view of the surgical site.

翻译：颅底手术是一个要求极高的领域，外科医生需在颅骨内部及周围操作，同时避开包括神经和血管在内的关键解剖结构。虽然图像引导的手术导航是当前的主流标准，但仍存在局限性，需要个性化规划并认可经验丰富外科医生的不可替代作用。本文提出了一种专为颅底手术辅助钻孔设计的协作控制机器人系统。我们的核心假设是，这种通过触觉辅助模式实现虚拟夹具的协作系统，有潜力显著提升手术安全性、提高效率并减轻外科医生的体力负担。本文详细描述了实现这些触觉辅助模式下的虚拟夹具所需的复杂系统开发工作。为验证系统的性能和有效性，我们开展了初步可行性实验，涉及一名医学生和两名经验丰富的外科医生。实验聚焦于在皮质乳突切除术后的关键结构周围进行钻孔，使用了牙科石模型和尸体模型。我们的实验结果表明，与缺乏触觉辅助的系统相比，所提出的触觉反馈机制能提高关键结构周围钻孔的安全性。借助我们的系统，即使手术部位视野受阻，外科医生也能安全地剥离关键结构，而不损伤任何关键结构。