Skull base surgery is a demanding field in which surgeons operate in and around the skull while avoiding critical anatomical structures including nerves and vasculature. While image-guided surgical navigation is the prevailing standard, limitation still exists requiring personalized planning and recognizing the irreplaceable role of a skilled surgeon. This paper presents a collaboratively controlled robotic system tailored for assisted drilling in skull base surgery. Our central hypothesis posits that this collaborative system, enriched with haptic assistive modes to enforce virtual fixtures, holds the potential to significantly enhance surgical safety, streamline efficiency, and alleviate the physical demands on the surgeon. The paper describes the intricate system development work required to enable these virtual fixtures through haptic assistive modes. To validate our system's performance and effectiveness, we conducted initial feasibility experiments involving a medical student and two experienced surgeons. The experiment focused on drilling around critical structures following cortical mastoidectomy, utilizing dental stone phantom and cadaveric models. Our experimental results demonstrate that our proposed haptic feedback mechanism enhances the safety of drilling around critical structures compared to systems lacking haptic assistance. With the aid of our system, surgeons were able to safely skeletonize the critical structures without breaching any critical structure even under obstructed view of the surgical site.

We study the problem of detecting critical structures using a graph embedding model. Existing graph embedding models lack the ability to precisely detect critical structures that are specific to a task at the global scale. In this paper, we propose a novel graph embedding model, called the Ego-CNNs, that employs the ego-convolutions convolutions at each layer and stacks up layers using an ego-centric way to detects precise critical structures efficiently. An Ego-CNN can be jointly trained with a task model and help explain/discover knowledge for the task. We conduct extensive experiments and the results show that Ego-CNNs (1) can lead to comparable task performance as the state-of-the-art graph embedding models, (2) works nicely with CNN visualization techniques to illustrate the detected structures, and (3) is efficient and can incorporate with scale-free priors, which commonly occurs in social network datasets, to further improve the training efficiency.