Exploration of new concepts for sensor based tissue specific laser surgery

在组织消融过程中，由于缺乏触觉反馈，激光手术的优势可能会减弱。外科医生没有收到关于切割底部被消融组织的确切激光穿透深度或类型的信息，这可能会导致医源性损伤或主要神经等解剖结构的破坏。由于到目前为止，激光外科的应用仅限于表面结构。为了使激光手术成为一种普遍适用的工具，有必要开发一种组织特异性可控外科激光。这一跨学科研究项目的目的是开发一种基于传感器的组织特异性反馈系统，以自动控制外科领域的激光消融。该研究项目特别关注通过远程光学组织识别来保护神经。实验选择了两种手术方式：在下牙槽神经附近的下颌骨截骨术和在面神经附近的腮腺手术。这些手术通常具有医源性神经损伤的高风险。通过漫反射和自荧光光谱结合Er：YAG激光组织消融产生的光学过程发射进行组织识别，从而在激光加工过程中提供恒定的反馈机制。在对实验数据进行评估后，将建立一个原理验证的消融传感器和反馈控制系统，并在体内动物实验中进一步验证。

The advantages of laser surgery can be diminished by the lack of haptic feedback during the ablation of tissue. A surgeon receives no information about the exact laser beam penetration depth or type of the ablated tissue at the bottom of the cut, risking to induce iatrogenic damage or destruction of anatomical structures like major nerves. Due to that the application of laser surgery is limited to superficial structures so far. To establish laser sugery as an universally applicable tool it is necessary to develp a tissue specific controlled surgical laser. It is the aim of this interdisciplinary research project to develp a sensorbased tissue specific feedback system to automatically control laser ablation in the surgical field. The research project sets a special focus on nerve preservation by remote optical tissue discrimination. Two surgical procedures are chosen for the experiments which typically inherit a high risk of iatrogenic nerve damage: the osteotomy of the mandible in the vicinity of the inferior alveolar nerve and the surgery of the parotid gland in the vicinity of the facial nerve. The tissue discrimination is conducted by diffuse reflectance and auto-fluorescence spectroscopy combined with optical process emissions caused by Er:YAG laser tissue ablation to provide a constant feedback mechanism during laser processing. After assessment of the experimental data, a proof-of-principle ablation sensor and feedback control system will be established and further validated on in vivo animal studies.