Compact laser applicator for robot-guided craniotomy in awake neurosurgery

Awake neurosurgical procedures allow surgeons to interact with patients during operations, facilitating real-time functional testing for 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 OCTbased depth monitoring, designed specifically for use with lightweight collaborative robots. The applicator enables fast, laser ablation of bone tissue over a 5×5 cm² scan field with micron level precision. Key features include beam position tracking, inertial sensing for motion and shock detection, and a miniaturized water spray nozzle for 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 workflows in the operating room and increase the acceptance of awake neurosurgery for improved clinical outcome.