On Friday March 19, 2021, we were delighted to welcome Antoine Petit, CEO at CNRS - Centre National de la Recherche Scientifique, to the Arnaud de Villeneuve campus as part of the signing of a partnership agreement with the University of Montpellier. We also welcomed Philippe Poignet, Director of the LIRMM Montpellier Laboratory of Computer Science, Robotics and Microelectronics, who presented the surgical robotics projects housed at the Faculty of Medicine.

 

Speech by Philippe Poignet, Director of LIRMM

 

During the event, we were visited by Philippe Poignet, Director of the Montpellier Laboratory of Computer Science, Robotics and Microelectronics. He took the opportunity to present the surgical robotics projects hosted by the Faculty of Medicine on the Arnaud de Villeneuve campus. These projects are led by a LIRMM team called DEXTER, whose aim is to design, build and control high-performance robots capable of fine, rapid and/or precise gestures.

 

Presentation of three surgical robotics projects

 

• A maxillofacial surgery project:

Project leaders: Dr. Marie de Boutray (PH, Maxillofacial Surgery and Stomatology at Montpellier University Hospital, and associate researcher in the LIRMM surgical robotics team) and Dr. Nabil Zemiti (MCU at UM) and Pr. Philippe Poignet (PU at UM) of the LIRMM surgical robotics team.

Funding: Fondation des gueules cassées, Labex CAMI, Labex Numev.

Project description: Currently, the gold standard for mandibular bone loss is autologous bone reconstruction using a fibular bone graft revascularized at the level of the cervical vessels. The main difficulty with this type of surgery lies in shaping the long, straight fibular bone into a flap angled in all 3 planes of space to adapt to the shape of the mandible to be reconstructed. At present, there are a number of means available to help the surgical team achieve this optimal 3D conformation, such as customized cutting guides and plates, or 3D printing models. But these techniques are still very costly and extremely time-consuming, which hinders their use in daily practice. The project leaders therefore set out to improve fibular conformation by using a collaborative robot to guide the surgical procedure. To this end, they have developed a robot-assisted fibular conformation technique coupled with virtual modeling of osteotomies. This project is currently undergoing pre-clinical validation on a cadaveric model at the Montpellier Faculty of Medicine.

• An orthopaedic shoulder surgery project:

Project leaders: Dr. Pierre-Emmanuel Chammas (Orthopedic Surgery, Montpellier University Hospital), Dr. Nabil Zemiti (MCU, UM) and Prof. Philippe Poignet (PU, UM) of the LIRMM surgical robotics team.

Project description: The significant ageing of Western populations is leading to an increase in the incidence of osteoporosis-related fractures and arthrosic pathologies. Arthroplasty, or prosthetic joint replacement, is a frequent indication for these pathologies in the shoulder (in 2010, 10,831 procedures in France). The medical and economic stakes are high, with the need to operate on more patients, with ever greater safety, precision and speed.

These conditions are necessary to ensure the shortest possible return to previous living conditions, and to maintain the person's autonomy, which is directly correlated with life expectancy in the elderly.

Optimal positioning of joint prostheses is one of the most important criteria for achieving the best post-operative functional result, the fewest possible complications, and a longer life for the prosthesis by limiting the risk of wear in the medium and long term.

In this context, and more specifically in total shoulder prosthesis surgery, correct positioning of the glenoid implant is a key determinant of functional outcome and longevity. It depends on the initial positioning of a guide pin. Conventional instrumentation is characterized by significant positioning variability, even when performed by expert clinicians. Computer-assisted surgical solutions enable precise, reproducible positioning, albeit with certain limitations. The initiators of this project proposed the use of robotic assistance for precise and reproducible positioning of the glenoid pin, compared with conventional instrumentation. In a pre-clinical study carried out at the Montpellier Faculty of Medicine, they demonstrated that this solution enabled more precise and reproducible angular positioning of the glenoid pin, irrespective of the operator's level of expertise.

• An ENT surgery project:

Project leaders: Dr. Fréderic Venail (PU-PH ENT Surgery at Montpellier University Hospital) and Dr. Nabil Zemiti (MCU at UM), Pr. Philippe Poignet (PU at UM) and Lucas Lavenir (PhD student at UM) from the LIRMM surgical robotics team.

Funding: Fondation Agir pour l'audition, Labex CAMI, Région Occitanie: Fondation Agir pour l'audition, Labex CAMI, Région Occitanie.

 

Project description: Cochlear implants are the first functional neuroprostheses to have been developed for human subjects. They restore auditory perception in individuals suffering from severe to profound deafness. Implantation of these prostheses requires insertion of an electrode holder into the cochlea, enabling electrical stimulation of the ends of the auditory nerve fibers.

Today, the insertion of this electrode array is a critical step in the surgical procedure, as it involves advancing this 1mm diameter electrode array into a small hole (~2mm) in the cochlea (round window). Clinically, this insertion is carried out manually, "blind" and without any possibility of control or correction of the trajectory inside the cochlea.

The lack of visual control and the poor manipulability of the electrode array are the cause of much damage to cochlear structures and subsequent loss of residual hearing. Such risks preclude cochlear implant implantation in individuals with milder hearing loss.

To address these issues, the project leaders are currently working (Lucas Lavenir's thesis) on the development of navigation software to guide the surgical procedure for fitting auditory neuroprostheses using a dedicated ultrasound probe....

This probe is carried by Collin Medical's RobOtol system, which enables automatic tracking of the insertion movement and guidance of the electrode.

The successful completion of this project will pave the way for safer therapeutic interventions for inner ear pathologies, such as in situ drug delivery or gene therapy, which cannot be performed safely with the tools currently available to ENT surgeons.

 

A partnership agreement for the period 2021-2026

CNRS and theUniversity of Montpellier renew their partnership for a second five-year period. This agreement between CNRS, the University of Montpellier, Paul Valéry University, the Ecole Nationale Supérieure de Chimie de Montpellier and the Région Académique d'Occitanie aims to define the elements of a shared scientific policy, implemented through the management of joint units and their operational implementation, by ratifying fundamental agreements on their management and operation.

 

The five main scientific areas of the partnership

 

 

 

A steering and monitoring committee

In order to monitor the partnership at both strategic and operational levels, the agreement provides for the creation of a steering and monitoring committee. The signatories undertake to share regular reports. The terms and conditions of this agreement are defined following a negotiation process guided by the objective of achieving balance and taking into account the specific features of the shared units.

 

We would like to thank Nabil Zemiti, leader of the three surgical robotics projects, for his invaluable help in writing this article.