An experimental evaluation of the force requirements for robotic mastoidectomy.

HYPOTHESIS During robotic milling of the temporal bone, forces on the cutting burr may be lowered by choice of cutting parameters. BACKGROUND Robotic bone removal systems are used in orthopedic procedures, but they are currently not accurate enough for safe use in otologic surgery. We propose the use of a bone-attached milling robot to achieve the required accuracy and speed. To design such a robot and plan its milling trajectories, it is necessary to predict the forces that the robot must exert and withstand under likely cutting conditions. MATERIALS AND METHODS We measured forces during bone removal for several surgical burr types, drill angles, depths of cut, cutting velocities, and bone types (cortical/surface bone and mastoid) on human temporal bone specimens. RESULTS Lower forces were observed for 5-mm diameter burrs compared with 3-mm burrs for a given bone removal rate. Higher linear cutting velocities and greater cutting depths independently resulted in higher forces. For combinations of velocities and depths that resulted in the same overall bone removal rate, lower forces were observed in parameter sets that combined higher cutting velocities and shallower depths. Lower mean forces and higher variability were observed in the mastoid compared with cortical/surface bone. CONCLUSION Forces during robotic milling of the temporal bone can be predicted from the parameter sets tested in this study. This information can be used to guide the design of a sufficiently rigid and powerful bone-attached milling robot and to plan efficient milling trajectories. To reduce the time of the surgical intervention without creating very large forces, high linear cutting velocities may be combined with shallow depths of cut. Faster and deeper cuts may be used in mastoid bone compared with the cortical bone for a chosen force threshold.