On Friday, March 19, 2021, we had the pleasure of welcoming Antoine Petit, CEO of the CNRS (French National Center for Scientific Research), to the Arnaud de Villeneuve campus for the signing of a partnership agreement with the University of Montpellier. We also welcomed Philippe Poignet, Director of the LIRMM Laboratory of Computer Science, Robotics, and Microelectronics in Montpellier, who presented the surgical robotics projects hosted by the Faculty of Medicine.

 

Speech by Philippe Poignet, Director of LIRMM

 

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

 

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 Prof. Philippe Poignet (PU at UM) from the LIRMM surgical robotics team.

Funding: Fondation des Gueules Cassées, Labex CAMI, Labex Numev.

Project description: Currently, when faced with mandibular bone loss, the gold standard is to perform autologous bone reconstruction using a free fibula flap (fibular bone graft) revascularized at the cervical vessels. The main difficulty with this surgery lies in shaping the long, straight fibular bone into a flap angled in three planes to fit the shape of the mandible to be reconstructed. Currently, there are ways to help the surgical team achieve this 3D shape in an optimal way, such as custom-made cutting guides and plates or 3D-printed models. However, these techniques remain very costly and extremely time-consuming, which hinders their use in everyday practice. The project leaders therefore focused on improving this fibular conformation by using a collaborative robot to guide the surgical procedure. To do this, they developed a robot-assisted fibular conformation technique coupled with virtual modeling of osteotomies. This project is currently undergoing preclinical validation on cadaver models at the Montpellier Faculty of Medicine.

• An orthopedic shoulder surgery project:

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

 Project description: The significantaging of Western populations is leading to an increase in the incidence of osteoporosis-related fractures and osteoarthritis. Arthroplasty, or prosthetic joint replacement, is a common treatment for these conditions in the shoulder (in 2010, 10,831 procedures were performed in France). The medical and economic challenges are significant, with the need to operate on more patients with ever-increasing safety, precision, and speed.

These conditions are necessary for a return to previous living conditions as quickly as possible and for maintaining the person's independence, which is directly correlated with life expectancy in the elderly.

The optimal positioning of joint prostheses is one of the most important criteria for achieving the best postoperative functional outcome, the fewest possible complications, and a longer prosthesis lifespan by limiting the risk of wear and tear in the medium and long term.

In this context, and more specifically in total shoulder replacement surgery, the correct positioning of the glenoid implant is one of the determining factors in the functional outcome and longevity of the implant. It depends on the initial positioning of a guide pin. Conventional instrumentation is characterized by significant variability in positioning, even when performed by expert clinicians. Computer-assisted surgery solutions allow for precise and reproducible positioning, with certain limitations. The project leaders proposed implementing robotic assistance for precise and reproducible positioning of the glenoid pin compared to the use of conventional instrumentation. In a preclinical study conducted at the Montpellier Faculty of Medicine, they demonstrated that this solution allowed for more precise and reproducible angular positioning of the glenoid pin, regardless of the operator's level of expertise.

• An ENT surgery project: 

Project leaders: Dr. Fréderic Venail (Professor and Head of ENT Surgery at Montpellier University Hospital) and Dr. Nabil Zemiti (Associate Professor at Montpellier University), Prof. Philippe Poignet (Professor at Montpellier University) and Lucas Lavenir (PhD student at Montpellier University) from the LIRMM surgical robotics team.

Funding: Fondation Agir pour l’audition (Act for Hearing Foundation), Labex CAMI, Occitanie Region.

 

Project description: Cochlear implants are the first functional neuroprostheses to have been developed for humans. They restore hearing in individuals with severe to profound deafness. Implanting these prostheses requires inserting an electrode array into the cochlea, allowing electrical stimulation of the auditory nerve fibers.

Today, inserting this electrode array is a critical step in the surgical procedure because it requires advancing this network of electrodes, which are 1 mm in diameter, into a small hole (~2 mm) in the cochlea (round window). This insertion is performed manually in the clinic, "blind" and without the possibility of controlling and correcting the trajectory inside the cochlea.

The lack of visual control and poor maneuverability of the electrode holder cause significant damage to cochlear structures and the resulting loss of residual hearing. This risk prevents cochlear implants from being used in individuals with milder hearing loss.

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

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

The outcome of this project will pave the way for safer therapeutic interventions for inner ear disorders, 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

The CNRS andthe University of Montpellier are renewing their partnership for a second five-year period. This agreement, which links the CNRS, the University of Montpellier, Paul Valéry University, the National School of Chemistry of Montpellier, and the Occitanie Academic Region, aims to clarify the elements of shared scientific policy, implemented through the management of joint units and its operational implementation by ratifying fundamental agreements on their management and functioning.

 

The five major scientific areas of the partnership

 

 

 

A steering and monitoring committee

In order to monitor the partnership, both strategically and operationally, the agreement provides for the establishment of a steering and monitoring committee. The signatories undertake to share reports on a regular basis. The terms of this agreement are defined following negotiations guided by the objective of achieving balance and taking into account the specific characteristics of the shared units.

 

We would like to thank Nabil Zemiti, leader of the three surgical robotics projects, who provided us with invaluable assistance in writing this article.