Ex vivo breach detection using electrical conductivity during robotic pedicle drilling in the spine

Safe navigation within the spinal subarachnoid space is constrained by its narrow, compliant, and delicate anatomy. Conventional catheters and continuum robots rely on proximal pushing, generating friction and shear along the tissue device interface that limit distal controllability and increase the risk of neural injury. Here, we present a 2 mm diameter eversion-growing robotic platform that enables friction minimised extension and steering within the human spinal subarachnoid space, validated through computational modelling, phantom experiments, and intact human cadaver studies. The robot integrates a miniature endoscope for real time intrathecal visualisation and advances by pressure driven tip eversion, localising motion to the distal tip while minimising translational sliding of the deployed body. Phantom experiments demonstrated reductions of 65.2% in mean interaction force and 48.0% in peak interaction force compared with matched push-based insertion. Physics based modelling showed that eversion based growth redistributed tissue loading, reducing local stress concentrations and interfacial shear relative to conventional insertion. In an intact human cadaver, the system achieved 150 mm of controlled intrathecal extension with concurrent fluoroscopic and endoscopic visualisation, providing access across multiple vertebral levels from a standard lumbar entry point. Postprocedural laminectomy and durotomy revealed no observable macroscopic disruption of the dura mater or surrounding neural structures. These results provide the first mechanically characterised and multimodally validated demonstration of eversion-based robotic navigation in intact human spinal anatomy, establishing a quantitative and procedural foundation for future intrathecal interventions. Further validation in larger anatomical cohorts and under physiological conditions will be required before clinical translation.

Manual craniotomy is a high-risk, skill-dependent procedure associated with surgeon fatigue and potential dural injury. While robotic approaches have improved safety, existing open-loop systems rely solely on preoperative images and cannot compensate for intraoperative registration errors or tissue deformation. To address this, we propose a human-inspired closed-loop robotic craniotomy framework that intelligently integrates preoperative planning with intraoperative execution. An adaptive dual-contour fusion algorithm is employed to generate trajectories that conform to complex cranial geometries while maintaining a consistent tool-bone relative pose. For intraoperative perception, a multimodal two-stage cross-modal attention block (CMA)-temporal convolutional network (TCN)-Transformer network combined with an adaptive Bayesian filter fuses force and acoustic signals to achieve robust breakthrough detection under varying bone conditions. Upon detection, an in-situ projection-based trajectory adjustment strategy dynamically compensates for depth deviations, enabling safe residual bone isolation. Experiments on bovine ribs show a breakthrough prediction accuracy of 97%, a detection latency of 0.048 +/- 0.097 s, and a maximum overshoot of 0.29 mm. All four ex vivo cranial experiments were successfully completed without dural injury. These results demonstrate that the proposed cybernetic framework enables safe and autonomous craniotomy with highly effective closed-loop control.

Percutaneous iliosacral screw fixation is an important minimally invasive treatment for unstable pelvic fractures. Because the sacroiliac region has complex anatomy and narrow screw corridors, the accuracy and safety of screw placement directly affect surgical outcomes. Accurate and reliable preoperative screw planning is therefore essential to improve surgical success and reduce intraoperative risks. Conventional preoperative planning typically requires surgeons to determine screw trajectories through manual measurements, a labor-intensive process that depends on subjective clinical experience. To address these challenges, we propose a fully automated pipeline for preoperative iliosacral screw planning in patients with pelvic fractures. Using patient-specific three-dimensional anatomy, the pipeline automatically identifies safe screw corridors and generates individualized insertion trajectories to support clinical preoperative planning. We evaluated the proposed pipeline on 200 clinical cases of pelvic fractures. Compared with conventional manual measurements, the safety margin of the safe insertion corridors increased by 2% across the four screw types, the mean planning time decreased by more than 90%, and the clinical acceptance rate reached 95%.