Extending the Capability of Using a Waterjet in Surgical Interventions by the Use of Robotics

In waterjet surgery, a thin high-pressure jet is used for dissections and surface abrasion of soft tissue. This selective preparation method preserves nerves and vessels, whereas the surrounding soft tissue is washed away. Objective: The aim of this study is to enhance the application field of this technique by resolving technological limitations. Methods: A technical task definition of handling a hand-guided waterjet applicator is derived from the literature. All reported procedures require to follow a trajectory superimposed with an oscillating movement. By introducing a robotic system and a specialized kinematic approach, the limited dexterity of the waterjet applicator is increased. Additionally, the system provides assistance by automatically performing parts of the task. Results: The method is applied to two different procedures: a minimally invasive dissection and a surface abrasion for open medical treatments. On the basis of experiments with gelatine phantoms, the performance of the method is shown for both procedures. Conclusion: In the minimally invasive use case, the reachability limited by the conventional manual tools is extended by the capabilities of the robotic system. Simultaneously, the handling is simplified by automation of the superimposed oscillation. In the surface abrasion case, a dense coverage of the treated area is achievable. The risk of cross infections could be reduced by spatial separation of patient and staff. Significance: Thus, the waterjet technology can be fully integrated into robotic surgery systems and benefit from their inherent abilities.