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Head surgery made simple: Robot worm can cut around corners

01 Dec 2015

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Extracting tumours from the within the inner ear has always been considered an extremely delicate and difficult process. In fact, it normally requires surgeons to remove the entire mastoid bone. However, in the future, all doctors will need to do is cut a tunnel of 5mm in diameter through the bone using a miniature robot named NiLiBoRo.

The system is capable of adjusting its path while drilling through bone to steer around sensitive tissue such as blood vessels and nerves. Researchers will be displaying the new technology at the Compamed exhibition from November 16-19 in Dusseldorf (Hall 08a, Booth K38).

NiLiBoRo

NiLiBoRo is held in place during surgery using its expandable bladders. Researchers are currently optimising the pocket geometry using multiple prototypes. Fraunhofer IPA

Surgery is unavoidable for treating inner ear tumours, but the inner ear is difficult to access. This is because it is covered by a cranial bone known as the mastoid, or petrosal bone. What's more, the surrounding tissue contains lots of nerves and blood vessels. For this reason the surgeons will cut out as much of the mastoid bone as needed until they have located each one of these sensitive structures. Only then can they be sure not to damage them. What this entails most of the time is the removal of the entire bone. The hole thus created is filled in with fatty tissue taken from the abdomen after the completion of the procedure.

Performing surgery through a 5mm wide tunnel

In the future this operation will be performed in a less invasive fashion, requiring just a small hole measuring 5mm in diameter through which the tumour can be resected from the inner ear. The technology that makes this possible goes by the name of NiLiBoRo, a German acronym that stands for 'Non-linear Drilling Robot.' The system is being developed by researchers in the Mannheim Project Group for Automation in Medicine and Biotechnology, part of the Fraunhofer Institute for Production Technology and Automation IPA, in cooperation with the Technical University of Darmstadt, the University of Aachen, and the Dusseldorf University Clinic. Drilling machines capable of boring a tunnel through bone already exist, but they can do so only in a straight line. "NiLiBoRo is the first one that can drill around corners as well," said project group scientist Lennart Karstensen. It is this particular characteristic that makes it possible to perform minimally invasive surgery on inner ear tumours. If the tunnel were to run in a straight line, it would at times come troublingly close to hitting nerves. To avoid injuring nerve tissue, the tunnel would have to be no more than 1mm to 2mm in diameter. However, it is impossible to perform surgery through such a small opening. The NiLiBoRo on the other hand is capable of steering around sensitive areas. This makes it possible to achieve a tunnel diameter of 5mm, which is wide enough to perform the operation.

Hydraulic lines allow the robot worm to crawl forward

So how does this 'worm' manage to drill around curves and corners through the mastoid bone? "The worm consists of a 'head' and a 'tail' section," explained Karstensen. "Both of these parts are connected with one another by means of a flexible bellows mechanism." The design is reminiscent of an articulated public transit bus in which the front and rear sections are coupled by means of a hose-like centre section that looks like an accordion.

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