RoSE: A Robotic Soft Esophagus for Endoprosthetic Stent Testing
RoSE: A Robotic Soft Esophagus for Endoprosthetic Stent Testing
复制标题
DOI：
10.1089/soro.2019.0205
复制
发表时间：
2020-08-04
期刊：
影响因子：
7.9
通讯作者：
Xu, Weiliang
中科院分区：
文献类型：
--
作者：
Bhattacharya, Dipankar;J.V. Ali, Sherine;Xu, Weiliang
软机器人系统非常适合于开发用于生物医学应用的设备。研制了一种仿生物机器人软食管（RoSE），作为吞咽困难治疗支架的体外试验装置。内支架置入术是治疗食管癌恶性狭窄引起的吞咽困难的一种即时和经济有效的治疗方法。然而，后期并发症，如支架移位，可能会削弱食管中的吞咽功效。食管壁上的支架径向力（RF）是避免支架移位的关键。由于在患者中进行的随机对照试验有限，支架设计和支架植入指南仍然缺乏建设性。为了解决知识不足问题，我们通过植入具有不同径向刚度特征的两枚支架（支架A和B）来研究RoSE的能力，以测量支架RF及其对支架移位的影响。此外，在吞咽下对RoSE进行了内镜测压，以研究支架植入和支架功能障碍对RoSE中的团内压力特征（IBPS）的影响，并进一步研究其对吞咽疗效的影响。在RoSE中植入的每枚支架均接受了一组具有各种测试变量（扩张速度和波长以及推注浓度）的实验。在本研究中，所进行的试验代表了RoSE应用于支架性能的广泛评估。通过比较支架A和B的结果，讨论了RoSE的可用性，以及前面提到的试验变量的各种组合。结果表明，较硬的支架B具有较高的RF，而支架A由于其较低的刚度而将其RF保持在较低的外径。这些结果还表明，在RoSE中长时间蠕动收缩下，需要高RF才能最大限度地减少支架移位。对于测压实验，支架A略微增加了IBPS，但更硬的支架B显著降低了IBPS，尤其是对于较高浓度的推注。研究发现，如果使用更硬的支架，可能会降低吞咽效果并导致复发性吞咽困难。因此，RoSE是一种创新的软机器人平台，能够测试各种内置支架，从而为支架测试领域的许多现有临床挑战提供解决方案。
Soft robotic systems are well suited for developing devices for biomedical applications. A bio-mimicking robotic soft esophagus (RoSE) is developed as anin vitrotesting device of endoprosthetic stents for dysphagia management. Endoprosthetic stent placement is an immediate and cost-effective therapy for dysphagia caused by malignant esophageal strictures from esophageal cancer. However, later stage complications, such as stent migration, could weaken the swallow efficacy in the esophagus. The stent radial force (RF) on the esophageal wall is pivotal in avoiding stent migration. Due to limited randomized controlled trials in patients, the stent design and stenting guidelines are still unconstructive. To address the knowledge deficit, we have investigated the capabilities of the RoSE by implanting two stents (stent A and B) of different radial stiffness characteristics, to measure the stent RF and its effect on the stent migration. Also, endoscopic manometry on the RoSE under peristalsis has been performed to study the impact of stenting and stent dysfunctionality on the intrabolus pressure signatures (IBPSs) in the RoSE, and further its effects on the swallowing efficacy. Each implanted stent in the RoSE underwent a set of experiments with various test variables (peristalsis velocity and wavelength, and bolus concentrations). In this study, the conducted tests are representative of the application of RoSE to perform a wide-ranging assessment of the stent behavior. The usability of RoSE has been discussed by comparing the results of stent A and B, for various combinations of the test variables mentioned earlier. The results have demonstrated that the stiffer stent B has a higher RF, whereas stent A maintained its RF at a low profile due to its lesser stiffness. The results have also implicated that a high RF is necessary to minimize the stent migration under prolonged peristaltic contractions in the RoSE. For the manometry experiments, stent A slightly increased the IBPS, but the stiffer stent B significantly decreased the IBPS, especially for the higher concentration boluses. It was found that if a stiffer stent buckles, it can reduce the swallow efficacy and cause recurrent dysphagia. Therefore, RoSE is an innovative soft robotic platform that is capable of testing various endoprosthetic stents, thereby offering a solution to many existing clinical challenges in the area of stent testing.