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Multicenter Study
. 2024 Nov 7;14(1):27160.
doi: 10.1038/s41598-024-68557-7.

Performance and safety evaluation of a cold ablation robot-guided laser osteotome (CARLO) in 28 midface osteotomies

Robert Köhnke  1 , Shih-Jan Chin  2 , Alexandre T Assaf  2 , Katja Helmbold  2 , Andreas A Müller  3 , Philipp Juergens  3   4 , Tobias Wilken  5 , Sibylle Hirsch  5 , Marta M Morawska  5 , Jan Wolff  6 , Ralf Smeets  2 , Lan Kluwe  2 , Daniel Holzinger  7 , Kurt Schicho  7 , Gabriele Millesi  7
Affiliations
Multicenter Study

Performance and safety evaluation of a cold ablation robot-guided laser osteotome (CARLO) in 28 midface osteotomies

Robert Köhnke et al. Sci Rep. .

Abstract

The CARLO (cold ablation robot-guided laser osteotome) is a compact device with integrated multiple sensory, steering and safety checking elements. A multi-center study was performed to evaluate the CARLO device for the linear part of midface osteotomy in 28 patients. Feasibility, success rate, safety, performance and experience of the surgeons were assessed and evaluated. All 28 procedures were completed with CARLO without falling back to the conventional methods, giving a technical success rate of 100%. For 27 (96%) cases, procedural success was achieved with cutting lines deviation less than 2 mm. For 25 procedures, the CARLO-cutting was conducted smoothly. In the other 3 cases, some minor difficulties related to the reference markers were reported. For 18 procedures, no change for the cutting path was necessary. For the other 10 cases, cut path was adapted. Intraoperative re-planning was possible, easy and quick without significant delay of the procedures. No CARLO-related adverse events were recorded. Especially, there was no unexpected and unusual bleeding during the CARLO-conducted osteotomy. The time needed for the registration ranged from 1 to 12 min (median = 4). The CARLO-cutting lasted for 5 to 21 min (median = 7). The present study demonstrated feasibility, simplicity, safety, reliability and accuracy of CARLO for the linear part of midface osteotomy.

Keywords: 3D-planning; Laser guided osteotomy; Orthognathic surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Planning and intraoperative view. (a) Typical location of the four preoperative defined locations for the accuracy measurement (tips of the mesio-buccal cuspids of the first molars and canine). Yellow: midface; red: maxilla; green: resected bone, gap. (b) Intraoperative view (same patient) of the cutting process, green light: tip of the cutting laser. Middle: Osteotomies that were shown in Fig. 1a, directly after cutting. Below: osteosynthesis of the maxillary correction with patient-specific implants.
Figure 2
Figure 2
Difference between the planned and the intraoperative measured distance to the reference landmarks.
Figure 3
Figure 3
Overlay of preoperative planned, cut maxillary segment (blue overlay) with postoperative outcome of the osteotomy (yellow) for a patient with pre- and postoperative CT images.
Figure 4
Figure 4
Histological staining of the sinuous line cutting surface.
Figure 5
Figure 5
Duration of the CARLO-registration (in minutes), the CARLO-cutting (in minutes) and the whole procedure (in hours). The thick lines in the boxes indicate the medians.
Figure 6
Figure 6
Wave-curved cutting line performed by CARLO in the frontal wall of the maxillary sinus of a cadaver.
See this image and copyright information in PMC

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