A Concentric Tube Robot System for Rigid Bronchoscopy: A Feasibility Study on Central Airway Obstruction Removal
A Concentric Tube Robot System for Rigid Bronchoscopy: A Feasibility Study on Central Airway Obstruction Removal
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DOI：
10.1007/s10439-019-02325-x
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发表时间：
2020-01-01
影响因子：
3.8
通讯作者：
Webster, Robert J., III
中科院分区：
文献类型：
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作者：
Gafford, Joshua B.;Webster, Scott;Webster, Robert J., III
最近出现了新的机器人系统来协助周围肺通路，但用于硬性支气管镜检查的机器人系统尚未开发出来。我们描述了一种新的机器人系统，它可以通过标准刚性支气管镜的端口提供薄型机器人操作器。操纵器弯曲和伸长以在内窥镜尖端提供手术工具的可操作性，而不需要内窥镜运动。我们描述了使用该系统在支气管镜下治疗中央呼吸道阻塞(CAO)的初步可行性研究。CAO在大肿瘤患者中很常见，可能危及生命，传统的硬性支气管镜治疗会使患者面临并发症的风险，包括牙齿折断、颈部创伤和口咽结构损伤，这是由于支气管镜倾斜和操作产生的巨大力量造成的。在这项研究中，我们使用了一个体外的绵羊呼吸道模型来展示医生使用机器人系统有效地移除组织和恢复呼吸道的能力。手术前和手术后的CT扫描显示，在体外动物模型中，该机器人能够将五次CAO手术的气道阻塞狭窄程度从平均75%降低到14%。使用身体实验，我们证明了机器人系统的潜力，大大减少了手术中施加在患者头部和颈部的力(从80.6 N减少到4.1N)。这些初步结果表明，使用我们新的刚性支气管镜机器人系统切除CAO是可行的，并且该方法有可能减少由于支气管镜角度而对患者施加的力，从而降低CAO手术中遇到的并发症的风险。
New robotic systems have recently emerged to assist with peripheral lung access, but a robotic system for rigid bronchoscopy has yet to be developed. We describe a new robotic system that can deliver thin robotic manipulators through the ports of standard rigid bronchoscopes. The manipulators bend and elongate to provide maneuverability of surgical tools at the endoscope tip, without endoscope motion. We describe an initial feasibility study on the use of this system to bronchoscopically treat a central airway obstruction (CAO). CAO is prevalent and can be life-threatening in patients with large tumors, and conventional rigid bronchoscopic treatments place patients at risk of complications including broken teeth, neck trauma and damage to oropharyngeal structures due to significant forces induced by bronchoscope tilting and manipulation. In this study, we used an ex vivo ovine airway model to demonstrate the ability of a physician using the robotic system to efficiently remove tissue and restore the airway. Pre- and post-operative CT scans showed that the robot was able to reduce the degree of airway obstruction stenosis from 75 to 14% on average for five CAO resections performed in an ex vivo animal model. Using cadaver experiments, we demonstrated the potential of the robotic system to substantially reduce the intraoperative forces applied to the patient's head and neck (from 80.6 to 4.1 N). These preliminary results illustrate that CAO removal is feasible with our new rigid bronchoscopy robot system, and that this approach has the potential to reduce forces applied to the patient due to bronchoscope angulation, and thereby reduce the risk of complications encountered during CAO surgery.