Ultrasound Robotic System to Multi-Approach Puncture for Endoscopic Spinal Surgery

Abstract

Ultrasound (US) imaging has been widely utilized for guiding puncture procedures in spinal interventions. However, conventional methods that confine puncture within the US plane may not adequately meet the demands of endoscopic spinal surgery (ESS), which requires extensive spatial orientation adjustments. In this study, we introduce a novel approach using a US robotic system (URS) integrated with a multi-approach puncture mechanism to aid in target localization and puncture assistance during ESS. The proposed mechanism incorporates a five-bar linkage structure with a remote center of motion (RCM) to drive the needle with two degrees of freedom, enabling significant orientation adjustments of 85<inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$^{\circ }$</tex-math></inline-formula> in the transverse plane and 140<inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$^{\circ }$</tex-math></inline-formula> in the coronal plane. Additionally, the probe holder module provides vertical adaptability of the probe and depth adjustment of the RCM on the US plane. Experimental validation on a cross-wire model demonstrates puncture accuracy of less than 3 mm, meeting clinical requirements for ESS. Furthermore, the system's clinical usability is demonstrated on a gel lumbar model, showcasing the entire process (imaging, targeting, navigating, and puncture assisting) from imaging to puncture assistance. The URS shows promise in significantly improving the puncture success rates in ESS while reducing technical dependencies.