The current gold standard of computer-assisted jaw reconstruction includes raising microvascular bone flaps with patient-specific 3D-printed cutting guides. The downsides of cutting guides are invasive fixation, periosteal denudation, preoperative lead time and missing intraoperative flexibility. This study aimed to investigate the feasibility and accuracy of a robot-assisted cutting method for raising iliac crest flaps compared to a conventional 3D-printed cutting guide.

In a randomized crossover design, 40 participants raised flaps on pelvic models using conventional cutting guides and a robot-assisted cutting method. The accuracy was measured and compared regarding osteotomy angle deviation, Hausdorff Distance (HD) and Average Hausdorff Distance (AVD). Duration, workload and usability were further evaluated.

The mean angular deviation for the robot-assisted cutting method was 1.9±1.1° (mean±sd) and for the 3D-printed cutting guide it was 4.7±2.9° (p<0.001). The HD resulted in a mean value of 1.5±0.6mm (robot) and 2.0±0.9mm (conventional) (p<0.001). For the AVD, this was 0.8±0.5mm (robot) and 0.8±0.4mm (conventional) (p=0.320). Collaborative robot-assisted cutting is an alternative to 3D-printed cutting guides in experimental static settings, achieving slot design benefits with less invasiveness and higher intraoperative flexibility. In the next step, the results should be tested in a dynamic environment with a moving phantom and on the cadaver.

The authors have declared no competing interest.

DRKS00031358

https://drks.de/search/de/trial/DRKS00031358

Behrus Puladi was funded by the Medical Faculty of RWTH Aachen University as part of the Clinician Scientist Program. We acknowledge FWF enFaced 2.0 [KLI 1044, https://enfaced2.ikim.nrw/] and KITE (Plattform für KI-Translation Essen) from the REACT-EU initiative [https://kite.ikim.nrw/, EFRE-0801977].

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee of RWTH Aachen University (approval number EK 23-149, date of approval 20.07.2023)

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