Feasibility of photoacoustic-guided teleoperated hysterectomies.
Feasibility of photoacoustic-guided teleoperated hysterectomies.
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DOI：
10.1117/1.jmi.5.2.021213
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Bell MAL
中科院分区：
文献类型：
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作者：
Allard M;Shubert J;Bell MAL
子宫切除术（即手术切除子宫）是治疗子宫癌、子宫内膜异位症和子宫脱垂等疾病的主要解决方案。子宫切除术的并发症之一是位于子宫动脉几毫米范围内的输尿管意外受伤，输尿管被切断和烧灼以阻碍血流并能够完全切除子宫。这项工作探讨了使用光声成像来可视化子宫动脉（以及可能的输尿管）的可行性，当这种成像方法与达芬奇®手术机器人独特结合时，可以实现远程操作子宫切除术。我们开发了一种专门的光传输系统来包围达芬奇®弯曲剪刀工具，并在外部放置超声波探头（代表经阴道方法）来接收声信号。当工具扫过我们定制的 3D 子宫血管模型时，获得光声图像，该模型覆盖有离体牛组织，该模型放置在 3D 模型和纤维之间，以及超声探头和 3D 模型之间。探索了四种工具方向，并使用机器人运动学在每次光声图像采集时同时提供工具位置和方向信息。最佳工具方向生成的图像具有对比度和背景信噪比 (SNR)，表明工具尖端的声学杂波最小。我们使用剪刀工具在开放和闭合配置中探索了四个独特的手腕方向，实现了类似的对比度和信噪比测量。结果表明，光声成像是一种很有前景的方法，可以实现子宫动脉可视化，从而指导子宫切除术（和其他妇科手术）。这些结果还适用于其他 da Vinci® 手术和具有类似尖端几何形状的其他手术器械。
Hysterectomies (i.e., surgical removal of the uterus) are the prevailing solution to treat medical conditions such as uterine cancer, endometriosis, and uterine prolapse. One complication of hysterectomies is accidental injury to the ureters located within millimeters of the uterine arteries that are severed and cauterized to hinder blood flow and enable full uterus removal. This work explores the feasibility of using photoacoustic imaging to visualize the uterine arteries (and potentially the ureter) when this imaging method is uniquely combined with a da Vinci® surgical robot that enables teleoperated hysterectomies. We developed a specialized light delivery system to surround a da Vinci® curved scissor tool, and an ultrasound probe was placed externally, representing a transvaginal approach, to receive the acoustic signals. Photoacoustic images were acquired while sweeping the tool across our custom 3-D uterine vessel model covered in ex vivo bovine tissue that was placed between the 3-D model and the fiber, as well as between the ultrasound probe and the 3-D model. Four tool orientations were explored, and the robot kinematics were used to provide tool position and orientation information simultaneously with each photoacoustic image acquisition. The optimal tool orientation produced images with contrast and background signal-to-noise ratios (SNRs) , indicating minimal acoustic clutter from the tool tip. We achieved similar contrast and SNR measurements with four unique wrist orientations explored with the scissor tool in open and closed configurations. Results indicate that photoacoustic imaging is a promising approach to enable visualization of the uterine arteries to guide hysterectomies (and other gynecological surgeries). These results are additionally applicable to other da Vinci® surgeries and other surgical instruments with similar tip geometry.