Body-mounted robotic instrument guide for age-guided cryotherapy of renal cancer
Body-mounted robotic instrument guide for age-guided cryotherapy of renal cancer
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DOI：
10.1118/1.4939875
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发表时间：
2016-02-01
期刊：
影响因子：
3.8
通讯作者：
Tokuda, Junichi
中科院分区：
文献类型：
--
作者：
Hata, Nobuhiko;Song, Sang-Eun;Tokuda, Junichi
目的：肾癌的图像引导冷冻治疗是手术肾切除术的新兴替代方案，特别是对于那些无法承受手术身体负担的人。众所周知，这种治疗的结果取决于冷冻治疗探头的准确放置。因此，机器人器械引导器可以帮助医生精确地瞄准冷冻治疗探头，以最大限度地提高治疗效果并避免对关键周围结构的损伤。本文的目的是提出一种机器人仪器指南定位冷冻治疗探头在图像引导冷冻治疗肾癌。作者提出了一个身体安装的机器人指南，预计将不太容易受到患者的全身motion.Methods所造成的指导错误：保持设备的最小足迹，作者开发并验证了一个身体安装，机器人仪器指南，可以保持设备和患者的身体之间的几何关系，即使在存在的患者的频繁的身体运动。引导件可以将冷冻治疗探头定向为以皮肤切口点为远程运动中心。作者的确认研究包括对机器人器械导向器的机械精度和位置可重复性的评价。作者还使用体模进行了模拟MRI引导冷冻治疗手术，通过引入器官运动来研究其对冷冻治疗探头准确放置的影响，以比较机器人辅助探头更换与徒手方法的优势。为性能分析收集的测量结果包括探头放置的准确性和时间。进行多变量分析以评估器官运动和机器人引导器中的一个或两个是否影响这些测量。使用机器人器械导向器放置探针的机械精度和位置可重复性分别为0.3和0.1 mm，体模测试表明，使用机器人器械导向器时，探头放置的准确性明显更好（4.1mm）比没有引导件（6.3mm，p < 0.001）的情况下更小，即使在存在身体运动的情况下。当人工添加独立器官运动时，除了身体运动外，使用机器人器械导向器准确放置探头的优势在统计学上消失[即，使用机器人导向器时为6.0 mm，不使用机器人导向器时为5.9 mm（p = 0.906）]。当使用机器人器械导向器时，完成手术所需的总时间从19.6分钟减少到12.7分钟（p < 0.001）。多变量分析表明，机器人器械导向器，而不是器官运动，是统计学显著性的原因。作者获得的统计功率是88%的准确性评估和99%的持续时间measurement.Conclusions高：身体安装的机器人仪器指南允许定位的探头在图像引导下的肾癌冷冻治疗，并在更少的尝试，在更短的时间比徒手的方法。在没有器官运动的情况下，使用机器人器械引导器的冷冻治疗探头放置的准确性优于不使用引导器的情况。当器官运动存在时，机器人和徒手方法之间的准确性变得相当。2016年美国医学物理学家协会。
Purpose: Image-guided cryotherapy of renal cancer is an emerging alternative to surgical nephrectomy, particularly for those who cannot sustain the physical burden of surgery. It is well known that the outcome of this therapy depends on the accurate placement of the cryotherapy probe. Therefore, a robotic instrument guide may help physicians aim the cryotherapy probe precisely to maximize the efficacy of the treatment and avoid damage to critical surrounding structures. The objective of this paper was to propose a robotic instrument guide for orienting cryotherapy probes in image-guided cryotherapy of renal cancers. The authors propose a body-mounted robotic guide that is expected to be less susceptible to guidance errors caused by the patient's whole body motion.Methods: Keeping the device's minimal footprint in mind, the authors developed and validated a body-mounted, robotic instrument guide that can maintain the geometrical relationship between the device and the patient's body, even in the presence of the patient's frequent body motions. The guide can orient the cryotherapy probe with the skin incision point as the remote-center-of-motion. The authors' validation studies included an evaluation of the mechanical accuracy and position repeatability of the robotic instrument guide. The authors also performed a mock MRI-guided cryotherapy procedure with a phantom to compare the advantage of robotically assisted probe replacements over a free-hand approach, by introducing organ motions to investigate their effects on the accurate placement of the cryotherapy probe. Measurements collected for performance analysis included accuracy and time taken for probe placements. Multivariate analysis was performed to assess if either or both organ motion and the robotic guide impacted these measurements.Results: The mechanical accuracy and position repeatability of the probe placement using the robotic instrument guide were 0.3 and 0.1 mm, respectively, at a depth of 80 mm The phantom test indicated that the accuracy of probe placement was significantly better with the robotic instrument guide (4.1 mm) than without the guide (6.3 mm, p < 0.001), even in the presence of body motion. When independent organ motion was artificially added, in addition to body motion, the advantage of accurate probe placement using the robotic instrument guide disappeared statistically [i e, 6 0 mm with the robotic guide and 5.9 mm without the robotic guide (p = 0.906)]. When the robotic instrument guide was used, the total time required to complete the procedure was reduced from 19.6 to 12.7 min (p < 0.001). Multivariable analysis indicated that the robotic instrument guide, not the organ motion, was the cause of statistical significance. The statistical power the authors obtained was 88% in accuracy assessment and 99% higher in duration measurement.Conclusions: The body-mounted robotic instrument guide allows positioning of the probe during image-guided cryotherapy of renal cancer and was done in fewer attempts and in less time than the free-hand approach. The accuracy of the placement of the cryotherapy probe was better using the robotic instrument guide than without the guide when no organ motion was present. The accuracy between the robotic and free-hand approach becomes comparable when organ motion was present. 2016 American Association of Physicists in Medicine.