Instrument flight to the inner ear
Instrument flight to the inner ear
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DOI：
10.1126/scirobotics.aal4916
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发表时间：
2017-03-15
期刊：
影响因子：
25
通讯作者：
Caversaccio, Marco
中科院分区：
文献类型：
--
作者：
Weber, Stefan;Gavaghan, Kate;Caversaccio, Marco
手术机器人系统的工作可以超越人类感知、灵巧性和规模的限制，使其本质上适合用于显微外科手术。然而，尽管进行了广泛的研究，但迄今为止，用于显微外科手术的图像引导机器人应用在临床护理中的引入有限。其中，挑战是几何尺度和触觉分辨率，外科医生无法充分控制人类能力范围之外的设备。需要机制来确定对过程变量的冗余控制，以确保设备的安全性，就像航空电子设备中的仪表飞行一样。髋关节植入手术是一种显微外科手术，其中特定的任务是在亚毫米尺度和超过可靠的视觉触觉反馈。髋关节植入术受术中和术中变化的影响，导致患者的临床和听力学结局可能不一致。机器人人工耳蜗植入的概念旨在提高手术结果的一致性，例如保留残余听力，并减少手术的侵入性。我们报告成功的图像引导，机器人人工耳蜗植入人体。机器人治疗模型包括计算机辅助手术计划、精确立体定向图像引导、组织特性原位评估和多极神经监测，所有这些都基于体外、体内和试点数据。该模型可扩展以集成额外的机器人功能，例如耳蜗通路和电极插入。我们的研究结果证明了使用机器人技术进行侧颅底显微手术的可行性和可能性。它有可能在其他显微外科领域受益，目前还没有面向任务的机器人技术。
Surgical robot systems can work beyond the limits of human perception, dexterity, and scale, making them inherently suitable for use in microsurgical procedures. However, despite extensive research, image-guided robotics applications for microsurgery have seen limited introduction into clinical care to date. Among others, challenges are geometric scale and haptic resolution at which the surgeon cannot sufficiently control a device outside the range of human faculties. Mechanisms are required to ascertain redundant control on process variables that ensure safety of the device, much like instrument flight in avionics. Cochlear implantation surgery is a microsurgical procedure, in which specific tasks are at submillimetric scale and exceed reliable visuo-tactile feedback. Cochlear implantation is subject to intra- and interoperative variations, leading to potentially inconsistent clinical and audiological outcomes for patients. The concept of robotic cochlear implantation aims to increase consistency of surgical outcomes, such as preservation of residual hearing, and to reduce invasiveness of the procedure. We report successful image-guided, robotic cochlear implantation in human. The robotic treatment model encompasses computer-assisted surgery planning, precision stereotactic image guidance, in situ assessment of tissue properties, and multipolar neuromonitoring, all based on in vitro, in vivo, and pilot data. The model is expandable to integrate additional robotic functionalities such as cochlear access and electrode insertion. Our results demonstrate the feasibility and possibilities of using robotic technology for microsurgery on the lateral skull base. It has the potential for benefit in other microsurgical domains for which there is no task-oriented robotic technology available at present.