Robot-Enabled Natural Orifice Prostatectomy

机器人自然孔道前列腺切除术

• 批准号: 9884762
• 负责人: S Duke Herrell
• 金额: $ 53.65万
• 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: 2019-04-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9884762
• 关键词: Abdomen; Address; Anastomosis - action; Animal Experiments; Cadaver; Caliber; Cancer Patient; Clinical; Clinical Trials; Communities; Complex; Complication; Devices; Dissection; Endoscopes; Excision; Fascia; Fiber; Fiber Optics; Future; Goals; Hand; Histology; Holmium; Impotence; Incontinence; Intervention; Intuition; Lasers; Ligaments; Liquid substance; Location; Malignant Neoplasms; Malignant neoplasm of prostate; Mechanics; Medical Imaging; Modeling; Morbidity - disease rate; Nature; Needles; Nerve; Neuroendoscopy; Operating Rooms; Operative Surgical Procedures; Patients; Pilot Projects; Procedures; Process; Prostate; Prostatectomy; Prostatic; Radical Prostatectomy; Recovery; Research; Robot; Robotics; Running; Speed; Sphincter; Structure; Structure of capsule of prostate; Surgeon; Surgical sutures; System; Techniques; Testing; Tissues; Tube; Urethra; Visualization; Work; animal tissue; arm; base; clinically significant; design; dexterity; experimental study; flexibility; functional outcomes; image reconstruction; improved; innovation; instrument; instrumentation; kinematics; men; mortality; neurovascular; novel; novel strategies; prostate surgery; public health relevance; reconstruction; repaired; response; robotic device; robotic system; soft tissue; success; tool; urinary; validation studies

Project Summary/Abstract: The objective of this proposal is to create a hand-held surgical robot for endoscopic transurethral radical prostatectomy. The new robot will deploy needle-sized arms through the endoscope, for independent tissue manipulation, laser aiming, and visualization, enabling resection of the prostate and reconstructive suturing. Clinical significance comes from (1) the large number of patients who could benefit (1 in 7 men will have prostate cancer in their lives; 161,000 new cases per year in the USA; 90,000 surgeries per year in the USA), and (2) the high morbidity of current surgical approaches (70% impotence, 21% incontinence, with 39% requiring a subsequent intervention to address complications, and a 1 in 5000 mortality rate). We hypothesize that the key to reducing rates of impotence, incontinence, and complications is minimal disruption to the delicate tissues surrounding the prostate, especially the neurovascular bundles that run on the outside of the prostate and control erectile function and the external sphincter that enables continence. Yet current surgical techniques approach the prostate from the abdomen, and thus require large dissection of the structures that surround the prostate in- cluding endopelvic fascia and prostatic ligaments, and manipulation and retraction of the neurovascular bundles. In contrast, we propose the novel approach of reaching the prostate from within, through the urethra, which is enabled by needle-size, tentacle-like robot manipulators delivered through an endoscope, to enable laser-based resection and dexterous reconstructive suturing. We hypothesize that such a system will improve functional out- comes and reduce complication rates, providing a much less invasive approach to performing prostate surgery. The innovation of our new robot is the ability to deliver needle-sized robotic arms through an endoscope. They are made up of telescoping, curved, elastic tubes. By axially rotating these tubes and telescopically extending them, our robot will provide the surgeon with two small tentacle-like arms at the tip of the endoscope. One arm will carry a holmium laser fiber for cutting, the other will enable tissue retraction, and both will work together to perform reconstructive suturing. This is the first hand-held robotic system to provide two-handed dexterity. It will enable suturing within a lumen as small as the urethra, a major technical innovation that we expect to be useful in many other surgical contexts in the future. Our approach consists of three Specific Aims. Aim 1 addresses the mechanical design of a sterilizable, hand- held robotic system suitable for the workflow of a real-world operating room. Aim 2 focuses on designing con- centric tube manipulators with novel needles and graspers at their tips that enable reconstructive suturing (anas- tomosis) from within the lumen to be repaired. Aim 3 consists of phantom, ex vivo animal tissue, and cadaver studies to experimentally validate our new transurethral approach to radical prostatectomy, evaluating resection quality via medical imaging and reconstruction quality via fluid testing.

项目摘要/摘要： 该提案的目的是创建一种用于内窥镜经尿道根治术的手持式手术机器人 新的机器人将通过内窥镜部署针大小的手臂，以进行独立的组织切除。 操纵、激光瞄准和可视化，实现前列腺切除和重建缝合。 临床意义来自于 (1) 大量患者可以受益（七分之一的男性将受益） 前列腺癌在美国每年新增病例 161,000 例； (2) 当前手术方法的高发病率（70% 阳痿，21% 失禁，39% 需要 随后采取干预措施解决并发症，死亡率为五千分之一）。 降低阳痿、失禁和并发症发生率的关键是尽量减少对脆弱组织的破坏 前列腺周围，尤其是在前列腺外部运行和控制的神经血管束 目前的手术技术方法无法实现勃起功能和外括约肌的控制。 从腹部切开前列腺，因此需要对前列腺周围的结构进行大范围解剖 包括骨盆内筋膜和前列腺韧带，以及神经血管束的操纵和牵拉。 相比之下，我们提出了一种通过尿道从内部到达前列腺的新方法，即 由通过内窥镜输送的针大小、触手状的机器人操纵器实现，以实现基于激光的 我们发现这样的系统将改善功能输出。 来减少并发症发生率，提供一种侵入性更小的方法来进行前列腺手术。 我们新型机器人的创新之处在于能够通过内窥镜输送针头大小的机械臂。 由可伸缩的弯曲弹性管组成，通过轴向旋转这些管并伸缩延伸。 对于他们，我们的机器人将为外科医生提供在内窥镜尖端的两个小触手状手臂。 将携带用于切割的钬激光光纤，另一个将实现组织收缩，两者将共同工作 这是第一个提供双手灵活性的手持式机器人系统。 能够在像尿道一样小的管腔内进行缝合，这是我们期望有用的一项重大技术创新 未来在许多其他外科手术中。 我们的方法由三个具体目标组成，目标 1 涉及可消毒的手动灭菌器的机械设计。 目标2侧重于设计con- 中心管机械手的尖端带有新颖的针和抓握器，可以进行重建缝合（anas- 目标 3 由体模、离体动物组织和尸体组成。 研究通过实验验证我们新的经尿道根治性前列腺切除术，评估切除情况 通过医学成像实现质量，通过液体测试实现重建质量。