Comparative Analysis of Autonomous Robotic and Manual Techniques for Ultrasonic Sacral Osteotomy: A Preliminary Study

In this paper, we introduce an autonomous Ultrasonic Sacral Osteotomy (USO) robotic system that integrates an ultrasonic osteotome with a seven-degree-of-freedom (DoF) robotic manipulator guided by an optical tracking system. To assess multi-directional control along both the surface trajectory and cutting depth of this system, we conducted quantitative comparisons between manual USO (MUSO) and robotic USO (RUSO) in Sawbones phantoms under identical osteotomy conditions. The RUSO system achieved sub-millimeter trajectory accuracy (0.11 mm RMSE), an order of magnitude improvement over MUSO (1.10 mm RMSE). Moreover, MUSO trials showed substantial over-penetration (16.0 mm achieved vs. 8.0 mm target), whereas the RUSO system maintained precise depth control (8.1 mm). These results demonstrate that robotic procedures can effectively overcome the critical limitations of manual osteotomy, establishing a foundation for safer and more precise sacral resections.