Autonomous medical needle steering in vivo
Autonomous medical needle steering in vivo
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DOI：
10.1126/scirobotics.adf7614
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发表时间：
2023-09-20
期刊：
影响因子：
25
通讯作者：
Alterovitz，Ron
中科院分区：
文献类型：
--
作者：
Kuntz，Alan;Emerson，Maxwell;Alterovitz，Ron
使用针进入器官内的部位对于许多用于诊断和治疗的介入医疗程序是基本的。由于存在解剖学障碍、高水平的不确定性和自然组织运动，安全且准确地将针穿过活组织导航到目标目前通常具有挑战性或不可行。能够自动化基于针头的手术的医疗机器人有可能克服这些挑战，并增强患者护理和安全性。然而，还没有示出针围绕障碍物自主导航到体内预定目标。在这里，我们介绍了一个医疗机器人，自主导航针通过活组织周围的解剖障碍，在体内的目标。我们的系统利用激光图案化的高度灵活的可操纵针，能够沿沿着曲线轨迹操纵。自主机器人占解剖障碍，组织/针相互作用的不确定性，呼吸运动使用重新规划，控制和安全插入时间窗口。我们将该系统应用于肺活检，这对诊断肺癌至关重要，肺癌是美国癌症相关死亡的主要原因。我们证明了我们的系统在多个体内猪研究中的成功性能，实现了小于临床相关肺结节半径的靶向误差。我们还证明，与标准手动支气管镜检查技术相比，我们的方法提供了更高的准确性。我们的研究结果显示了在活组织中部署自主可控针机器人的可行性和优势，以及这些系统如何扩展医生的现有能力，以进一步改善患者护理。
The use of needles to access sites within organs is fundamental to many interventional medical procedures both for diagnosis and treatment. Safely and accurately navigating a needle through living tissue to a target is currently often challenging or infeasible because of the presence of anatomical obstacles, high levels of uncertainty, and natural tissue motion. Medical robots capable of automating needle-based procedures have the potential to overcome these challenges and enable enhanced patient care and safety. However, autonomous navigation of a needle around obstacles to a predefined target in vivo has not been shown. Here, we introduce a medical robot that autonomously navigates a needle through living tissue around anatomical obstacles to a target in vivo. Our system leverages a laser-patterned highly flexible steerable needle capable of maneuvering along curvilinear trajectories. The autonomous robot accounts for anatomical obstacles, uncertainty in tissue/needle interaction, and respiratory motion using replanning, control, and safe insertion time windows. We applied the system to lung biopsy, which is critical for diagnosing lung cancer, the leading cause of cancer-related deaths in the United States. We demonstrated successful performance of our system in multiple in vivo porcine studies achieving targeting errors less than the radius of clinically relevant lung nodules. We also demonstrated that our approach offers greater accuracy compared with a standard manual bronchoscopy technique. Our results show the feasibility and advantage of deploying autonomous steerable needle robots in living tissue and how these systems can extend the current capabilities of physicians to further improve patient care.