Robot-Automated Cartilage Contouring for Complex Ear Reconstruction: A Cadaveric Study
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© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA) Objectives/Hypothesis: Auricular reconstruction requiring manual contouring of costal cartilage is complex and time consuming, which could be facilitated by a robot in a fast and precise manner. This feasibility study evaluates the accuracy and speed of robotic contouring of cadaver costal cartilage. Methods: An augmented robot with a spherical burr was used on cadaveric rib cartilage. Using a laser scanner, each rib section was converted to a three-dimensional model for preoperative planning. A model ear was also scanned to define a carving path for each piece of cartilage. After being contoured, each specimen was compared against the preoperative plan utilizing deviation maps to analyze topographic accuracy. Contouring times of the robot were compared with 13 retrospectively reviewed cases (2006–2017) by an experienced surgeon. Results: Scanning the cartilage sections took 24.8 ± 6.8 seconds. Preoperative processing took an additional 29.9 ± 8.9 seconds for the preparation of the contouring path. Once the path was prepared, the robot contoured the specimens with a root mean square error of 0.54 mm and a mean absolute deviation of 0.40 mm. The average time to contour the specimens with the robot was 13 ± 2 minutes compared to 71 ± 6 minutes for the manual contouring in the reviewed cases. Conclusions: The accuracy of the robotic system was high, with submillimeter deviations from the preoperative plan. The robot required <20% of the contouring time compared to the experienced surgeon. This represents a fast and accurate alternative to hand-contouring costal cartilage grafts for auricular reconstruction. Laryngoscope, 2020.