Blood vessel detection, localization and estimation using a smart laparoscopic grasper: a Monte Carlo study
Blood vessel detection, localization and estimation using a smart laparoscopic grasper: a Monte Carlo study
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DOI：
10.1364/boe.9.002027
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发表时间：
2018-05-01
影响因子：
3.4
通讯作者：
Subramanian, Hariharan
中科院分区：
文献类型：
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作者：
Chaturvedi, Amal;Shukair, Shetha A.;Subramanian, Hariharan
几个世纪以来，外科医生一直依靠他们的触觉来识别重要的结构，如传统的开放手术中的血管。在过去的二十年里，外科医生已经转向微创手术（MIS）方法，包括腹腔镜手术，其优点包括疤痕较少，感染风险较低，恢复时间更快。事实上，由于这些好处，一些手术，如胆囊切除术，已经有超过80%的人采用了这项技术。然而，由于与使用腹腔镜手术相关的基本挑战，在更复杂的专业中采用率较低，例如结直肠和胸外科，其中手术领域有出血，脂肪，瘢痕组织和粘连。这些问题会因炎症、癌症、慢性病、肥胖和再次手术等复杂因素而加剧。重要的是，如果外科医生因为这些复杂因素而无法继续使用微创方法，他们通常会从腹腔镜手术转为开放手术，从而否定患者本应看到的受益。当外科医生尝试这些手术时，手术平均需要30分钟- 1小时。一种新的方法，外科医生可以可视化血管等结构，可以减少转换率和手术时间，从而推动腹腔镜手术在这些复杂手术中的更大采用。在这里，我们表明，通过添加近红外（NIR）LED和线性图像传感器到腹腔镜抓钳的相对钳口上，可以有效地检测和定位嵌入组织内的血管，即使是使用当前成像技术不可见的血管。我们展示了Monte Carlo模拟的结果来支持我们的主张，包括可以检测到2至6 mm的血管和埋在高达1 cm的组织下。我们还报告开发了一个智能抓钳手持原型运行离体实验。这些实验的结果与蒙特卡罗模拟的结果相匹配，并且估计的血管尺寸与实际尺寸表现出很强的相关性。这项技术将被纳入现有的腹腔镜工具，以协助外科医生在MIS手术。(C)2018美国光学学会
For centuries, surgeons have relied on their sense of touch to identify vital structures such as blood vessels in traditional open surgery. Over the past two decades, surgeons have shifted to minimally invasive surgical (MIS) approaches, including laparoscopic surgery, which include benefits such as less scarring, less risk for infection, and quicker recovery times. In fact, some surgeries such as cholecystectomies have seen more than an 80% adoption of this technique because of those benefits. However, due to the fundamental challenges associated with using laparoscopic surgery, there has been a lower adoption in more complex specialties, such as colorectal and thoracic surgery, where the field of surgery has bleeding, fat, scar tissue, and adhesions. These problems are exacerbated by complicating factors such as inflammation, cancer, chronic disease, obesity, and re-operations. Importantly, surgeons will often convert from laparoscopy to open surgery if they can no longer proceed using the minimally invasive approach because of issues described with these complicating factors, thereby negating the benefits that the patient would have seen. When the surgeon does attempt these procedures with those issues, the surgery takes on average 30 min - 1 hour longer. A new method by which surgeons can visualize structures like blood vessels could reduce the conversion rates and operating time, thereby driving a greater adoption of laparoscopic surgery in these complex procedures. Here, we show that by adding near infrared (NIR) LEDs and a linear image sensor onto the opposing jaws of the laparoscopic graspers, blood vessels that are embedded within tissues can be detected and localized efficiently, even those not visible using current imaging techniques. We show the results of Monte Carlo simulations to support our claim, including that blood vessels ranging from 2 to 6 mm and buried under up to 1 cm of tissue can be detected. We also report developing a smart grasper handheld prototype to run ex vivo experiments. The results of these experiments matched with those of the Monte Carlo simulations and the estimated blood vessel size showed a strong correlation with the actual size. This technology will be incorporated into already existing laparoscopic tools to assist surgeons during MIS procedures. (C) 2018 Optical Society of America