OCT-Guided Free-Hand Semi-Automated Microsurgical Tool for Enhanced Retinal Surge

OCT 引导徒手半自动显微手术工具，用于增强视网膜电涌

• 批准号: 8192410
• 负责人: PETER LOUIS GEHLBACH
• 金额: $ 35.9万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8192410
• 关键词: Address; Blindness; Cannulas; Clinical; Clinical Research; Clinical Trials; Detection; Development; Devices; Discipline; Environment; Epiretinal Membrane; Evaluation; Eye; Family suidae; Fiber Optics; Financial compensation; Forcep; Frequencies; Goals; Hand; Hand functions; Human; Imagery; Injection of therapeutic agent; Injury; Intervention; Laboratories; Manuals; Mechanics; Membrane; Microinjections; Microscope; Microsurgery; Modeling; Modification; Motion; Movement; Natural regeneration; Needles; Operative Surgical Procedures; Ophthalmology; Optical Coherence Tomography; Optics; Oryctolagus cuniculus; Outcome; Penetration; Performance; Physiological; Positioning Attribute; Procedures; Process; Relative (related person); Retina; Retinal; Risk; Safety; Scientist; Severities; Site; Staging; Surface; Surgeon; Surgical Error; Surgical incisions; System; Techniques; Technology; Testing; Therapeutic Agents; Thick; Time; Tissues; Training; Translating; Translations; Validation; Variant; Vitrectomy; Work; base; clinically relevant; design; egg; empowered; ergonomics; experience; grasp; head-to-head comparison; improved; in vivo; instrument; motor control; optical imaging; optical sensor; practical application; tool

DESCRIPTION (provided by applicant): Contemporary retinal microsurgery is performed by skilled surgeons through operating microscopes, utilizing free hand techniques and manually operated precision micro-instruments. We have assembled an interdisciplinary team including a clinician scientist and vitreoretinal surgeon, an optical device scientist and a systems integrator to translate existing and developing technology in our laboratories into practical application. To this end we will produce, test in dry and wet models and validate the proposed instrument(s) in vivo. Here we will build upon our previous and ongoing work in fiber optic imaging, sensing and motion detection and control to build a platform for enhancing the surgeon's ability to visualize optically transparent tissues, to identify and track tissue edges, to maintain surgical position, to detect early instrument contact with tissue and to assess depth of tissue penetration. In order to provide these extended capabilities we will incorporate our optical sensor based surface topology, motion limiting and compensation technology into a microsurgery guidance tool that can be placed into the eye. The system will be capable of one-dimensional real-time depth tracking, limitation of tool motion, motion compensation and active surgical targeting and intervention. From initial design the platform will evolve towards a compact and lightweight as well as ergonomically designed tool for free hand use by a micro-surgeon. Three functional surgical tools will be integrated into the visualization and guidance system in order to provide extended surgical capabilities at the site of tool to retina contact. These will include a simple microinjection cannula that will allow assessment of tool tip position, tool-retina contact and depth of retinal penetration as well as to directly deliver therapeutic agents into the retina. The second surgical function will be a surgical blade with tool axis motion and incision depth constrained by surface topology as well as motion limiting and compensation technology utilized for tool guidance. The surgical objective of the tool is to incise the internal limiting membrane with minimal damage to the underlying retina. The strategy for minimizing damage will be to constrain automated cut depth, to limit tool motion and to improve visualization and control of the tool tip relative to the retinal surface. The third surgical tool will be a micro-forceps that will utilize our integrated forward directed common-path optical coherence tomography function in order to assist in identifying visually transparent surgical edges and in tracking surgical progress. Each unique tool application will be quantitatively evaluated using demonstrative dry and wet phantoms in use in our laboratory as well as the ex vivo porcine eye model. At all points in the evaluation process an experienced vitreoretinal surgeon will critically evaluate and propose clinically relevant tool refinements and modifications. Finally, in vivo testing and tool validation, using a rabbit eye model, will be used to advance the technology to a clinical research ready, application. PUBLIC HEALTH RELEVANCE: This proposal addresses fundamental limitations in current vitreoretinal surgery by developing functional free-hand surgical tools that could empower micro-surgeons to achieve surgical objectives, diminish surgical risk and improve outcomes in all microsurgical fields. Further, these capabilities are broadly applicable in other microsurgical problems, and the tools will enable further advances both for ophthalmology and for other microsurgical disciplines.

描述（由申请人提供）：当代视网膜显微外科手术是由熟练的外科医生通过操作显微镜进行的，利用自由手工技术和手动操作的精确微型启动。我们组建了一个跨学科团队，包括临床医生和玻璃体外科医生，光学设备科学家和系统集成商，以将我们实验室中的现有技术转化为实际应用。为此，我们将在干燥和湿的模型中生产，测试，并在体内验证拟议的仪器。 在这里，我们将基于以前且正在进行的工作，用于光纤成像，感应和运动检测和控制，以建立一个平台，以增强外科医生可视化光学透明的组织，识别和跟踪组织边缘，维持手术位置，维持手术位置，检测早期仪器与组织的接触并评估组织深度渗透的能力。为了提供这些扩展的功能，我们将将基于光学传感器的表面拓扑，运动限制和补偿技术纳入可以放入眼睛中的显微外科指导工具中。该系统将能够进行一维实时深度跟踪，刀具运动的限制，运动补偿以及主动手术靶向和干预。从初始设计开始，平台将发展为紧凑，轻巧以及符合人体工程学设计的工具，可自由使用微毛皮。 将将三种功能性手术工具集成到可视化和引导系统中，以便在视网膜接触工具部位提供扩展的手术功能。这些将包括一个简单的微注射套管，该套管将允许评估工具尖端位置，刀具接触和视网膜穿透深度以及直接将治疗剂传递到视网膜中。第二个手术功能将是一个手术刀片，其刀具轴运动和切口深度受表面拓扑的约束，运动限制和补偿技术用于刀具引导。该工具的手术目的是切割内部限制膜，对基础视网膜的损害极小。最小化损害的策略将是限制自动切割深度，限制工具运动并改善相对于视网膜表面的刀具尖端的可视化和控制。第三个手术工具将是一种微型手术，它将利用我们集成的向前定向的通用path光学相干断层扫描功能，以帮助识别视觉上透明的手术边缘并跟踪手术进度。每种独特的工具应用将使用在我们实验室中使用的指示性干和湿幻象以及离体猪眼模型进行定量评估。在评估过程中，经验丰富的玻璃体外科医生将批判性地评估并提出与临床相关的工具修补和修改。最后，使用兔眼模型的体内测试和工具验证将用于将技术推向临床研究，应用。 公共卫生相关性：该提案通过开发功能性手术手术工具来解决当前玻璃体视网膜手术中的基本限制，这些手术工具可以赋予微型外科医生的能力以实现手术目标，减少手术风险并改善所有显微外科领域的结果。此外，这些功能广泛适用于其他微型外科问题，这些工具将使眼科和其他微外科学科的进一步发展。