Deformation Corrected Image Guided Laparoscopic Liver Surgery

变形校正图像引导腹腔镜肝脏手术

• 批准号: 10437069
• 负责人: WILLIAM Robert JARNAGIN
• 金额: $ 7.45万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10437069
• 关键词: Ablation; Adjuvant; Advocate; Algorithms; Anatomy; Blinded; Blood Vessels; Cancer Patient; Caring; Cessation of life; Clinical; Clinical Trials; Cohort Studies; Coupled; Data; Data Science; Disease; Disease Management; Electroporation; Enrollment; Evaluation; Excision; Frequencies; Goals; Gold; Hemorrhage; Hepatectomy; Heterogeneity; Human; Image; Image-Guided Surgery; Incidence; Insufflation; Intervention; Investigation; Length of Stay; Ligaments; Liver; Liver diseases; Location; Malignant neoplasm of liver; Measurement; Medicine; Memorial Sloan-Kettering Cancer Center; Metastatic Neoplasm to the Liver; Methods; Modeling; Morbidity - disease rate; Navigation System; Neoadjuvant Therapy; Neoplasms in Vascular Tissue; Operative Surgical Procedures; Optics; Organ; Outcome; Patient Care; Patient Schedules; Patients; Positioning Attribute; Randomized; Research; Risk; Robotics; Role; Safety; Scientific Advances and Accomplishments; Services; Supervision; Surface; Survival Rate; System; Techniques; Technology; Testing; Therapeutic; Thermal Ablation Therapy; Time; Translations; Transplantation; Ultrasonography; Unresectable; Work; advanced disease; base; biomechanical model; cost; data acquisition; efficacy evaluation; image guided; imaging biomarker; improved; innovation; instrumentation; microwave ablation; minimally invasive; novel; novel strategies; operation; prospective; robot assistance; soft tissue; surgery outcome; therapy outcome; time use; tumor; validation studies

Summary The scientific premise underpinning this application is that technologies relating the precise physical location of therapy and co-located spatially-encoded disease information, i.e. usually provided by imaging, will enable safer less invasive liver surgical procedures thus increasing surgical candidacy and allowing for more accurate interventions. Going further, this improvement in localization will facilitate the analysis of outcomes for evaluating efficacy, the comparison of approaches, the rating of improvements, and the impact of imaging biomarkers to drive therapy decisions. In this application, while there is potentially broad clinical impact, the specific focus is facilitating and quantifying the spatial accuracy and fidelity of localized image-based information to enhance navigational assistance during laparoscopic liver surgery. Realization would be a fundamental advance in the domain of procedural medicine. The application hypothesis is that biomechanical model-based registration coupled to non-contact digitization can account for soft-tissue deformations and localize intraparenchymal liver targets to an unprecedented error of less than 3 mm of error on average. In addition, we will begin to explore the impact of this technology on locoregional therapies. What also sets this application apart is the strong translational trajectory of the technology through our proposed integration with the on FDA cleared liver guidance system. Another distinction for the application is that we have employed an assessment framework enlisting one of the best hepatopancreatobiliary services in the world at Memorial Sloan Kettering Cancer Center under the supervision of Dr. William R. Jarnagin for the independent evaluation of the technology. This decade+ long collaborative relationship among the co-PIs has been extremely productive (see Multi-PI plan) and is among the most scientifically substantive in the field of image guided liver navigation. The specific aims of the application involve: (1) the integration of deformation correction into a commercial guidance system, (2) the investigation of a novel approach to the laparoscopic indication which includes advances in a non-contact digitization and novel enhancements for modeling insufflation, ligament support, and model heterogeneity, (3) three clinical bystander studies that quantitatively characterize improvements in digitization, and the laparoscopic approach, and (4) an exploratory study that initiates the investigation of the use of the platform for locoregional therapies. In summary, while the focus of the application is a fundamental advance in liver cancer surgical care, it also offers a paradigm shift by providing a novel investigational framework in human systems within the context of procedural medicine.

概括 该应用程序的基础的科学前提是，与 治疗和共同确定的空间编码疾病信息，即通常由成像提供，将使更安全 侵入性肝外科手术较少 干预措施。进一步，本地化的这种改进将有助于分析结果 评估功效，方法的比较，改进的评分以及成像的影响 生物标志物推动治疗决策。在此应用中，虽然潜在的临床影响很大，但 具体的重点是促进和量化基于图像的信息的空间准确性和忠诚度 在腹腔镜手术期间增强导航援助。认识将是一个基本 在程序医学领域发展。应用假设是基于生物力学模型 耦合与非接触数字化的注册可以说明软组织变形并本地化 掌内肝的靶标的误差平均误差少于3 mm。另外，我们 将开始探索该技术对局部疗法的影响。什么也设置了此应用程序 通过我们提出的与ON FDA的集成，这是该技术的强大转化轨迹 清除肝引导系统。该应用程序的另一个区别是我们已经采用了评估 在纪念斯隆·克特林（Memorial Sloan Kettering 在威廉·R·贾纳金（William R. Jarnagin）博士的监督下，癌症中心对该技术进行了独立评估。 这十年+共同工作之间的长期协作关系非常有生产力（请参阅Multi-Pi计划） 并且是图像引导肝导航领域中最科学的实质性之一。具体目标 应用的涉及：（1）将变形校正整合到商业指导系统中，（2） 对腹腔镜指示的新方法的研究，其中包括非接触术的进步 数字化和新颖的增强功能，用于建模，韧带支持和模型异质性，（3） 三项临床旁观者研究，这些研究定量地表征了数字化的改善和腹腔镜的研究 方法和（4）探索性研究启动了对局部区域平台使用的调查 疗法。总而言之，虽然该应用的重点是肝癌手术护理中的基本进步，但 它还通过在上下文中提供人类系统中的新型研究框架来提供范式转变 程序医学。