Presently there are limited applications of automation within operative ENT. This proof-of-concept study explores the use of an augmented robot to contour cadaveric costal cartilage for auricular reconstruction. Ordinarily this task is performed manually. This takes considerable time due to the intricate features of the cartilage which must be reproduced to ensure a cosmetically satisfactory outcome. Robot automation for milling and contouring are widely available in other industries. The authors modified an existing six-axis robot to direct an orthopaedic surgical burr stylus. An intact ear was surface scanned with a handheld laser/optical scanner to create a three-dimensional computer model of the intended auricular shape. This model was fed into a computer numerical control software programme to generate a contouring path for the robot to take on 11 pieces of cadaveric costal cartilage. The time taken to scan, create the computer model and to carve the cartilage was recorded. These times were compared to the operative time taken for 13 surgical cases where cartilaginous grafts were manually shaped with a 15 blade by a surgeon. The robotically prepared cartilage graft was accurate within 0.5mm of the preoperative plan. The mean time taken to contour the cartilage was 13 minutes compared to 71 minutes with the traditional carving process. Although this was a feasibility study, the accuracy and speed demonstrated by robot-automated contouring offers an opportunity to improve standardisation, clinical outcomes and surgical time. The small form factor of the equipment suggests it can be readily accommodated within an operating theatre. Further studies providing data from real world application of this study will be valuable in advancing this innovating approach to auricular reconstruction.
Automated contouring of costal cartilage for pinna reconstruction – a proof of concept
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