Compact laser applicator for robot-guided craniotomy in awake neurosurgery

Awake neurosurgical proceduresallow surgeons to interact with patients during operations, facilitating real-time functional testingfor improved clinical outcome. However, the traditional method of opening the skull using saws and high-speed drills puts severe stress on patients due to the associated noise and vibrations. We present a compact laser scanning applicator that combines laser ablation with OCT-based depth monitoring, designed specifically for use with lightweight collaborative robots. The applicatorenablesfast, laser ablation of bone tissueover a 5×5 cm² scan fieldwith micron level precision. Key features include beam positiontracking, inertial sensing for motion and shock detection, and a miniaturized water spray nozzlefor efficient tissue ablation. We demonstrate carbonization-free bone cuts and real-time OCT-based monitoring of ablation depth in ex vivo sheep models. The presented laser-osteotome can enable safer,robot-guided laser surgical workflowsin the operating roomand increase the acceptance of awake neurosurgery for improved clinical outcome.