''Mechanically-intelligent'' Intra-operative Tissue Assessment for Robot-Assisted Surgery (MIRAS)

术中组织评估是微创手术的关键使能技术。外科医生通过“锁眼”或类似的方式进行微创手术，需要识别不同的结构或病变区域，即使这些看起来都很相似。这项工作的目的是确定癌症手术的切除边缘，以便切除肿瘤和边缘，以确保完全切除癌症，但不切除不必要的多余组织。目前，这样的手术切缘是通过外科医生的经验、手术前拍摄的各种图像以及外科医生在手术过程中可以进行的任何视觉观察或触觉“感觉”来确定的。手术切缘的最终确定依赖于术后组织病理学，切除的组织在显微镜下进行评估。只有这样，才能知道切除是否成功，或者是否需要进一步的手术和/或更积极的术后治疗。这些挑战在手术切除直肠和一些盆腔器官的肿瘤时尤其严重，因为手术切除的范围受到高度功能重要解剖结构的限制，例如供应膀胱、肠道、性器官和下肢的神经和血管。微创技术的发展（如腹腔镜或直肠或结肠等身体导管手术）已经消除了对组织特征的手术“感觉”，包括对手术边缘的评估。这凸显了临床对确定最佳手术切缘的定量、稳健、可靠和循证方法的未满足需求，并向外科医生提供反馈，以便在手术过程中做出决定。机器人辅助手术（RAS）是微创手术的下一个发展方向，在治疗各种疾病方面发展迅速。它通过让外科医生更好地控制器械和提供3D可视化等功能，提高了临床准确性。这种发展在骨盆和直肠等狭窄空间特别有用。到目前为止，RAS在肿瘤手术中的应用有限，主要是因为目前的RAS系统几乎完全依赖于视觉反馈，不能为临床决策提供支持。这项工作旨在提供RAS的新功能，以提高术中临床决策。这项技术将加速RAS在许多类型的内脏和实体器官手术中的发展，在这些手术中，视觉反馈有限或不足以可靠地确定手术边缘。这一合作伙伴关系汇集了4个具有两个临床专业的不同且互补的工程团队，并得到了两个行业的支持，一个是医疗传感器领域的中小企业，另一个是手术机器人制造商。该小组将专注于两个主要目标：1。设计一种可通过标准微创手术器械展开的微加工探针，能够在手术中对组织表面进行机械测量。2. 建立数据建模方法，对实时测量数据进行处理，形成手术切缘的定量评估，作为术中反馈给外科医生。该方法将在一系列分阶段的试验中发展，包括在离体人体组织和体内动物模型上，最终在手术环境中进行演示。通过这项工作，双方希望开发出一种独特的、面向未来的“ras制造智能”技术，用于手术中肿瘤和肿瘤边缘的识别，并进一步推广到其他手术领域。

Intra-operational tissue assessment is a key enabling technology for minimally invasive surgery. Surgeons operating along a "keyhole" or similar means of access for minimally invasive surgery need to identify different structures or diseased areas, even when these all may look similar. This work is aimed at identifying the resection margin in cancer surgery, to allow the removal of a tumour together with a margin which is just enough to ensure complete cancer excision, but without unnecessary excess tissue removal. Currently, such a surgical margin is identified using a combination of the surgeon's experience, images of various kinds taken prior to the operation coupled with any visual observations, or tactile 'feel' in the scenario of open surgery, that the surgeon can make during the operation. Ultimate confirmation of the surgical margin relies on post-operative histopathology, where the removed tissue is assessed microscopically. Only then, will it be known if the removal has been successful or if further surgery and/or more aggressive post-operative treatment is required. These challenges are particularly acute in surgical removal of tumours from the rectum and some pelvic organs, where wider surgical excision is constrained by close proximity of anatomical structures with high functional importance, e.g. nerves and vasculature supplying bladder, bowel, sexual organs and lower limbs. The development of minimally invasive techniques (such as laparoscopy or operations along body ducts, such as in the rectum or colon) have removed surgical 'feel' for tissue characteristics, including assessment of surgical margin. This highlights an unmet clinical need for a quantitative, robust, reliable and evidence-based method of determining the optimal surgical margin and providing feedback to the surgeon in a way that it can be used to make decisions during the operation.Robot-Assisted Surgery (RAS) is the next development in minimally invasive surgery and has seen rapid development in treatment of a wide variety of conditions. It offers improved clinical accuracy by giving surgeons better control of instruments and providing features such as 3D visualisation. Such developments are particularly useful in confined spaces such as the pelvis and rectum. So far, RAS has found limited application in oncological surgery, mostly because current RAS systems rely almost entirely on visual feedback, and do not provide support for clinical decision making. This work aims to provide a novel function in RAS to enhance intra-operative clinical decision making. This technology would accelerate development of RAS in many types of visceral and solid-organ surgery where visual feedback is limited or inadequate to determine surgical margins reliably.This partnership brings together 4 distinct and complementary engineering groups with two clinical specialisms and is supported by two industries, an SME in the medical sensors area and a manufacturer of surgical robots. The group will focus on two principal aims: 1. to devise a microfabricated probe deployable via a standard minimally invasive surgery instrument capable of making intra-operative mechanical measurements on the tissue surface. 2. to establish data modelling methods in order to process the real-time measurement data to produce quantitative assessment of surgical margin as intra-operative feedback to the surgeon.The approach will be developed in a staged series of trials, including on ex vivo human tissue and in vivo animal models, with ultimate demonstration in a surgical environment. Through the work, the partnership expects to develop a unique and future-proof 'RAS-made-smarter' technology for applications in intra-operative identification of tumours and tumour margins and, by extension, in other surgical areas.