Purpose: We explain our concept for customization of a guidance instrument, present a prototype, and describe a set of experiments to evaluate its positioning and drilling accuracy.

Methods: Our concept is characterized by the use of bone cement, which enables fixation of a specific configuration for each individual surgical template. This well-established medical product was selected to ensure future intraoperative fabrication of the template under sterile conditions. For customization, a manually operated alignment device is proposed that temporarily defines the planned trajectory until the bone cement is hardened. Experiments (n  =  10) with half-skull phantoms were performed. Analysis of accuracy comprises targeting validations and experiments including drilling in bone substitutes.

Results: The resulting mean positioning error was found to be 0.41  ±  0.30  mm at the level of the target point whereas drilling was possible with a mean accuracy of 0.35  ±  0.30  mm.

Conclusion: We proposed a cost-effective, easy-to-use approach for accurate instrument guidance that enables template fabrication under sterile conditions. The utilization of bone cement was proven to fulfill the demands of an easy, quick, and prospectively intraoperatively doable customization. We could demonstrate sufficient accuracy for many surgical applications, e.g., in neurosurgery. The system in this early development stage already outperforms conventional stereotactic frames and image-guided surgery systems in terms of targeting accuracy.