Robotic Natural Orifice Skull Base Surgery

机器人自然孔道颅底手术

• 批准号: 9066645
• 负责人: Robert James Webster
• 金额: $ 38.17万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9066645
• 关键词: Address; Algorithm Design; Algorithms; Anterior nares; Blindness; Bone Tissue; Brain; Cadaver; Caliber; Carotid Arteries; Clinic; Clinical; Complex; Complication; Craniotomy; Curette; Data; Devices; Disease; Dura Mater; Employee Strikes; Endoscopes; Excision; Face; Feedback; Forcep; Geometry; Health; Heart; Hormonal; Hospitalization; Image; Imagery; In Vitro; Incidence; Laboratories; Location; Lung; Magnetism; Measurement; Measures; Mechanics; Medical Imaging; Modeling; Motion; Nasal cavity; Navigation System; Needles; Operating Rooms; Operative Surgical Procedures; Pain; Patients; Performance; Physicians; Pituitary Gland; Pituitary Neoplasms; Primary Brain Neoplasms; Public Health; Research; Research Subjects; Resected; Robot; Robotics; Safety; Site; Skull Base Neoplasms; Surgeon; Surgical Instruments; System; Techniques; Tissues; Translating; Trauma; Tremor; Tube; Visual; Work; base; bone; clinical practice; cranium; design; design and construction; dexterity; fetus surgery; haptics; image guided; infancy; instrument; instrumentation; meningioma; novel; prevent; research study; robot control; skull base; standard of care; tool; tumor

DESCRIPTION (provided by applicant): The objective of this proposal is to reduce the invasiveness and increase the safety of surgical procedures at the skull base by introducing a new robotic system for natural orifice skull base surgery. Despite compelling patient benefits compared to highly invasive transfacial and transcranial approaches, the endonasal approach - in which surgical instruments are deployed to the skull base through a nostril and the nasal cavities - is only used in a small percentage of cases due to limitations in current surgical instrumentation. The proposed system aims to remedy this through a new kind of surgical robot with needle-diameter, tentacle-like instruments. It will be able to transport surgical tools and cameras along curvilinear paths and work "around corners" (e.g. enable physicians to resect tumors by curving around the carotid arteries), while providing the physician with a comfortable and intuitive control interface conceptually similar to that of the da Vinci Surgical System. Such a robot, with instruments made using concentric, curved, elastic tubes, has the potential to profoundly impact public health because: (1) incidence is high - 15-20% of all primary brain tumors occur in the pituitary and 1 in 5 people will develop one, with 1 in 120 requiring skull base surgery (>1cm tumor); (2) traditional approaches are highly invasive - they require either deconstruction of facial tissue and bone, or a craniotomy and associated trauma to the brain; and (3) there exists an underutilized, yet clinically proven alternative - the endonasal approach, which is not more widely deployed due to the difficulty of accomplishing it using conventional surgical tools. The proposed system will be developed through three Specific Aims. Aim 1 involves measuring surgical forces and geometry and using this information with mechanics models to optimally design the proposed robotic system. Aim 2 addresses developing control, force feedback, and assistance algorithms for the surgeon, together with visual displays showing endoscope images, registered preoperative medical images, and robot instrument locations. Magnetic tracking will enable force sensing and enhance the accuracy of surgical navigation. Aim 3 consists of experiments designed to evaluate robot performance in reaching surgically relevant locations, and in removing tissue in laboratory settings, in skull phantoms, and in cadaver studies. The final objective of this R01 is a fully functional robotic system with al the components necessary for operating room use, to assist the surgeon in natural orifice (i.e. transnasal) skull base surgery.

描述（由申请人提供）：该提案的目的是通过引入一种新的用于天然孔口颅底手术的机器人系统来降低颅底手术程序的侵入性并提高外科手术的安全性。尽管与高度侵入性的跨种族和经颅方法相比，具有令人信服的患者益处，但由于当前手术仪器的限制，由于少量病例使用了鼻鼻虫方法 - 通过鼻孔和鼻腔部署到颅底手术仪器。拟议的系统旨在通过一种新型的手术机器人和针直径的触手仪器来解决此问题。它将能够沿曲线路径运输外科手术工具和相机，并在“拐角处”工作（例如，可以使医生在颈动脉周围弯曲肿瘤），同时为医生提供舒适且直觉的控制界面在概念上与Da vincii Surgical System的概念相似。这样的机器人使用使用同心，弯曲，弹性管制成的仪器，具有深远影响公共卫生的潜力，因为：（1）发病率很高-15-20％的所有原发性脑肿瘤中的15-20％出现在垂体中，而5人中有1人会出现一个，而120人中有1人需要颅底手术（> 1cm肿瘤）； （2）传统方法是高度侵入性的 - 它们需要对面部组织和骨骼的解构，或者需要对大脑的颅骨切开术以及相关的创伤； （3）存在未充分利用但临床证明的替代方案 - 鼻nasal方法，由于难以使用传统的手术工具来实现它，该方法并没有更广泛地部署。提出的系统将通过三个特定目标开发。 AIM 1涉及测量手术力和几何形状，并将这些信息与力学模型一起使用，以最佳设计拟议的机器人系统。 AIM 2解决了外科医生为外科医生开发控制，强制反馈和辅助算法，以及显示内窥镜图像，注册的术前医疗图像和机器人仪器位置的视觉显示。磁跟踪将使力传感并提高手术导航的准确性。 AIM 3由实验组成，旨在评估在到达手术相关位置以及在实验室环境中，头骨幻像和尸体研究中去除组织的实验。该R01的最终目标是一个功能齐全的机器人系统，其用户使用所需的组件可以帮助外科医生进行天然孔口（即跨纳萨尔）颅底手术。

项目成果

A Wrist for Needle-Sized Surgical Robots.

• DOI: 10.1109/icra.2015.7139428
• 发表时间: 2015-05
• 期刊: IEEE International Conference on Robotics and Automation : ICRA : [proceedings]. IEEE International Conference on Robotics and Automation
• 作者: York PA;Swaney PJ;Gilbert HB;Webster RJ 3rd
• 通讯作者: Webster RJ 3rd

Rapid, Reliable Shape Setting of Superelastic Nitinol for Prototyping Robots.

• DOI: 10.1109/lra.2015.2507706
• 发表时间: 2016
• 期刊: IEEE robotics and automation letters
• 影响因子: 5.2
• 作者: Gilbert HB;Webster RJ 3rd
• 通讯作者: Webster RJ 3rd

An experimental feasibility study on robotic endonasal telesurgery.

• DOI: 10.1227/neu.0000000000000623
• 发表时间: 2015-04
• 期刊: Neurosurgery
• 影响因子: 4.8
• 作者: Wirz R;Torres LG;Swaney PJ;Gilbert H;Alterovitz R;Webster RJ 3rd;Weaver KD;Russell PT 3rd
• 通讯作者: Russell PT 3rd

Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study.

• DOI: 10.1177/0278364915585397
• 发表时间: 2015-11
• 期刊: The International journal of robotics research
• 作者: Hendrick RJ;Mitchell CR;Herrell SD;Webster RJ 3rd
• 通讯作者: Webster RJ 3rd

Elastic Stability of Concentric Tube Robots: A Stability Measure and Design Test.

• DOI: 10.1109/tro.2015.2500422
• 发表时间: 2016-02
• 期刊: IEEE transactions on robotics : a publication of the IEEE Robotics and Automation Society
• 作者: Gilbert HB;Hendrick RJ;Webster RJ 3rd
• 通讯作者: Webster RJ 3rd