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LBR Med in medical technology: robotic laser system for bone surgery

Swiss-based AOT AG has developed an innovative process for bone surgery: cold, robot-guided laser ablation. This robot-guided laser surgery is carried out with great precision using a KUKA robot that is certified in compliance with the relevant standards.

The greatest stories are based on real life, as they say – and real life sometimes has a way of coming up with the best innovations. Complex orthodontic surgery undergone by his daughter was the catalyst for a personal meeting between laser researcher Dr. Alfredo E. Bruno and Prof. Dr. Dr. Hans-Florian Zeilhofer, Head of the Oral & Maxillofacial Surgery department of the University Hospital Basel and the Canton Hospital Aarau. The technical exchange of this meeting and the combination of the two areas of competence to create robot-guided laser ablation gave rise to Advanced Osteotomy Tools AG, or AOT for short. 

CARLO: robotic laser system for bone surgery with the LBR Med

Our goal was to achieve radical improvement in the results of bone surgery by replacing mechanical cutting instruments with non-contact “cold” laser photoablation and medical robots.

Dr. Alfredo E. Bruno, now Chief Scientific Officer (CSO) and member of the administrative board at AOT

Robot-guided laser ablation as the future of surgery

Their joint brainchild was given the name CARLO, which stands for Cold Ablation, Robot-guided Laser Osteotome.For Prof. Hans-Florian Zeilhofer, CARLO represents the future of surgery because the software-guided robotic laser system for bone surgery supported by the LBR Med can perform highly precise cuts with any required pattern. “There are far more options open to the surgeon than with previous procedures.”

Until now, there was no solution for keeping the bone tissue in the area of the laser cutting surfaces intact and alive. CARLO now combines a laser and a robot for bone surgery in the form of the new “cold” laser technology with a small, lightweight, tactile robot designed for direct human-machine cooperation. The system is rounded off with complex 3D planning, navigation and control software and hardware. It slots seamlessly into the operating room and works autonomously, but provides the surgeon with full control of the procedure at all times. 

Using the LBR Med, AOT AG is revolutionizing the results of bone surgery with robot-guided laser ablation

Robot-guided laser surgery supported by the LBR Med increases precision

In order to achieve this precision, the system requires not only the laser and the navigation system, but also a robot. This makes the programmed cuts with millimeter precision and meets the requirements in terms of high sensitivity. It was thus almost inevitable that the path should lead AOT AG to the LBR Med from KUKA. “It meets all our requirements and is currently the best robot that is available on the market,” says Dr. Alfredo Bruno. “And since it is already certified for integration into a medical product, that saves us time with approval.”

The focus is on the safety of the laser and robot for bone surgery

How does CARLO work? The surgeon carries out the preoperative planning on the basis of data from a CT scan and feeds it into CARLO’s navigation system. An intuitive app guides the surgeon and technical staff through CARLO’s initialization step by step. The robot then performs the operation independently. If anything does not go as planned, the physician merely has to touch the robot gently and the system stops immediately. “The LBR Med has a whole range of extremely fine sensors. It is quicker than stopping a human assistant,” says Prof. Hans-Florian Zeilhofer. “The robot then moves to a wait position and resumes the procedure from precisely this position as soon as it receives the all clear.”
Precision work with robot-guided laser ablation

This is all still in the future, however, as far as the laser and robot for bone surgery are concerned, because certification as a medical product is still in progress. “Since CARLO is the first system of its kind, the supervisory authorities are understandably placing very high requirements on its safety,” explains Dr. Alfredo E. Bruno. AOT AG is already working on the development of the second generation of CARLO with enhanced safety and performance features. These are tools that will place further demands on the LBR Med. 

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