Preliminary Porcine In Vivo Evaluation of a Telerobotic System for Transurethral Bladder Tumor Resection and Surveillance
Preliminary Porcine In Vivo Evaluation of a Telerobotic System for Transurethral Bladder Tumor Resection and Surveillance
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DOI：
10.1089/end.2018.0119
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发表时间：
2018-06-01
影响因子：
2.7
通讯作者：
Simaan, Nabil
中科院分区：
文献类型：
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作者：
Sarli, Nima;Del Giudice, Giuseppe;Simaan, Nabil
导言：经尿道膀胱肿瘤电切术(TURBTS)可能是一项具有挑战性的手术，主要是由于工具提示的灵活性、可视化以及缺乏组织深度信息的限制。开发了一种经尿路机器人系统，通过解决其中的一些局限性，使TURBTS发生革命性的变化。给出了使用该新型机器人系统进行的三项猪体内试验的结果，并根据实验观察提出了潜在的改进意见。材料和方法：在全身麻醉下，将装有光学跟踪摄像机的经膀胱内窥镜置于猪的膀胱内。在内窥镜下，将组织凝胶处理凝胶与蓝色染料混合，经腹部注射到膀胱壁的不同位置，产生模拟的膀胱病变。然后使用7自由度(DoF)机器人对这些模拟肿瘤进行经尿道电切/消融。一个独立的2-DOF远端激光臂(DLA)通过机器人进行激光消融，并由手动控制的夹持器辅助进行整体切除。结果：使用我们的新型内窥镜机器人在猪的膀胱内创建和消融了病变。膀胱完全可及，包括膀胱颈和膀胱顶，不需要膀胱放气或耻骨压迫。用Ho激光消融模拟病变。使用DLA和手动夹持器进行整块切除。结论：机器人辅助下的肿瘤整块切除是可行的。主要挑战是缺乏深度知觉和由经膀胱内窥镜造成的视觉遮挡。给出了改进机器人辅助TURBTS的建议。通过这些试验性猪研究获得的经验教训验证了机器人辅助TURBTS的可行性，同时向设计师提供了未来临床部署所需的关键方面的信息。
Introduction: Transurethral resection of bladder tumors (TURBTs) can be a challenging procedure, primarily due to limitations in tooltip dexterity, visualization, and lack of tissue depth information. A transurethral robotic system was developed to revolutionize TURBTs by addressing some of these limitations. The results of three pilot in vivo porcine studies using the novel robotic system are presented and potential improvements are proposed based on experimental observations. Materials and Methods: A transvesical endoscope with a mounted optically tracked camera was placed through the bladder of the swine under general anesthesia. Simulated bladder lesions were created by injecting HistoGel processing gel mixed with blue dye, transabdominally, into various locations in the bladder wall under endoscopic visualization. A 7-degree-of-freedom (DoF) robot was then used for transurethral resection/ablation of these simulated tumors. An independent 2-DoF distal laser arm (DLA) was deployed through the robot for laser ablation and was assisted by a manually controlled gripper for en bloc resection attempts. Results: Lesions were created and ablated using our novel endoscopic robot in the swine bladder. Full accessibility of the bladder, including the bladder neck and dome, was demonstrated without requiring bladder deflation or pubic compression. Simulated lesions were ablated using the holmium laser. En bloc resection was demonstrated using the DLA and a manual grasper. Conclusion: Feasibility of robot-assisted en bloc resection was demonstrated. Main challenges were lack of depth perception and visual occlusion induced by the transvesical endoscope. Recommendations are given to enhance robot-assisted TURBTs. Lessons learned through these pilot swine studies verify the feasibility of robot-assisted TURBTs while informing designers about critical aspects needed for future clinical deployment.