''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。外科医生沿着“锁孔”或类似的微创手术进入方式进行手术，需要识别不同的结构或病变区域，即使这些结构或病变区域看起来都很相似。这项工作旨在确定癌症手术中的切除边缘，以允许将肿瘤连同刚好足以确保完全切除癌症的边缘一起切除，但不需要切除不必要的多余组织。目前，使用外科医生的经验、在手术之前拍摄的各种图像以及任何视觉观察的组合，或者外科医生在手术期间可以在开放手术的情况下进行的触觉“感觉”来识别这种手术边缘。手术切缘的最终确认依赖于术后组织病理学，其中通过显微镜评估切除的组织。只有这样，才能知道是否成功取出，或者是否需要进一步的手术和/或更积极的术后治疗。这些挑战在从直肠和一些盆腔器官手术切除肿瘤时尤其严重，其中更广泛的手术切除受到具有高功能重要性的解剖结构（例如，供应膀胱、肠、性器官和下肢的神经和脉管系统）的紧密接近的限制。微创技术的发展（如腹腔镜检查或沿着体管（如直肠或结肠）的手术）已经消除了组织特征的手术“感觉”，包括手术切缘的评估。这突出了一个未得到满足的临床需求，即需要一种定量、稳健、可靠和循证的方法来确定最佳手术切缘，并以一种可用于在手术过程中做出决策的方式向外科医生提供反馈。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仪器并提供3D可视化等功能来提高临床准确性。这种发展在骨盆和直肠等狭窄空间中特别有用。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，并且不为临床决策提供支持。这项工作的目的是提供一个新的功能，在RAS，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，这些手术的视觉反馈有限或不足以可靠地确定手术边缘。这种合作关系汇集了四个不同的互补工程团队，两个临床专业，并得到两个行业的支持，一个是医疗传感器领域的SME，另一个是手术机器人制造商。该小组将侧重于两个主要目标：1.设计一种可通过标准微创手术器械展开的微加工探针，该探针能够在组织表面上进行术中机械测量。2.建立数据建模方法，以处理实时测量数据，从而对手术切缘进行定量评估，作为术中反馈给外科医生。该方法将在一系列阶段性试验中开发，包括体外人体组织和体内动物模型，最终在手术环境中进行演示。通过这项工作，该合作伙伴关系预计将开发一种独特的、面向未来的“RAS制造更智能”技术，用于肿瘤和肿瘤边缘的术中识别，并扩展到其他外科领域。

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.