Ultrasound Guidance for a Laparoscopic Surgical Robot

描述(由申请人提供)：这份提案代表了直觉外科系统公司和约翰霍普金斯大学合作伙伴关系的第二阶段。第一阶段展示了将腹腔镜超声(LUS)能力集成到达芬奇中的可行性和前景。第二阶段将为LUS引导的肝脏手术开发一个完整、集成的应用环境和试验床外科应用程序。我们的总体目标是在微创环境中提供“开放式”超声检查的图像质量和可访问性，同时提高外科医生进行超声引导操作的能力。第二阶段系统将为肝脏手术提供一个具有LUS能力的达芬奇系统的潜力的现实评估，以及对设计选择和开发功能的权衡的评估。第二阶段有3个具体目标：具体目标1：开发LUS辅助机器人手术所需的功能能力。我们将扩展第一阶段架构，以提高健壮性、灵活性和评估的适宜性。其他功能增强包括铰接式机器人LU探头、原型活组织检查和消融工具、用于超声成像和靶向病变的改进的半自动行为、集成到daVinci用户界面中的LU可视化能力以及允许外科医生与LUS系统、图像和系统的其他功能交互的界面的其他重大增强。具体目标2：制造一个用于LUS辅助肝脏手术的集成机器人系统。我们将结合这些功能来生产一种适用于3种肝脏程序的体内测试系统：1)评估(分期)以定位和测量肿瘤；2)放置针头用于活组织检查/消融；以及3)切除小肿瘤。在每种情况下，目标都是将目标1中开发的基本功能与足够的特定应用工具和软件相结合，为开发提供必要的临床相关环境，并支持目标3中建议的评估。具体目标3：通过体内评估和体外模型评估整个系统和特定功能的有效性。成功的第二阶段将为一种产品奠定基础，该产品将使外科医生能够以目前开放剖腹手术所具有的图像质量和灵活性，以微创方式执行美国指导下的肝脏手术。这有可能降低发病率，提高肝癌治疗的疗效和效率。

DESCRIPTION (provided by applicant): This proposal represents the second phase of an STTR partnership involving Intuitive Surgical Systems and Johns Hopkins University. Phase I demonstrated the feasibility and promise of integrating laparoscopic ultrasound (LUS) capability into daVinci. Phase II will develop a complete, integrated application environment and testbed surgical applications for LUS-guided liver surgery. Our general goal is to provide the image quality and access of "open" ultrasonography in a minimally-invasive environment, while also improving the surgeon's ability to do ultrasound-guided procedures. The Phase II system will provide a realistic evaluation of the potential of an LUS-capable daVinci system for hepatic surgery as well as evaluation of the design choices and trade-offs in the functions developed. Phase II has 3 specific aims: Specific Aim 1: Develop functional capabilities required for LUS-assisted robotic surgery. We will extend the Phase I architecture to improve robustness, flexibility, and suitability for evaluation. Other functional enhancements include an articulated robotic LUS probe, prototype biopsy and ablation tools, "virtual fixtures" and improved semi-automated behaviors for ultrasound imaging and targeting of lesions, LUS visualization capabilities integrated into the daVinci user interface, as well as other significant enhancements to the interface permitting the surgeon to interact with LUS system, images, and other functions of the system. Specific Aim 2: Produce an Integrated Robotic System for LUS-Assisted Hepatic Surgery. We will combine these capabilities to produce a system suitable for in-vivo testing of 3 hepatic procedures: 1) assessment (staging) to locate and measure tumors; 2) Needle placement for biopsy/ablation; and 3) resection of small tumors. In each case, the goal is to combine the fundamental capabilities developed in Aim 1 with sufficient application-specific tooling and software to provide necessary clinically relevant context for development and to support the evaluations proposed in Aim 3. Specific Aim 3: Evaluate the effectiveness of the overall system and specific functions for hepatic surgery through in-vivo evaluations and ex vivo phantoms. A successful Phase II will provide the foundation of a product that will enable surgeons to perform US-guided hepatic procedures in a minimally invasive manner with the image quality and dexterity currently available with open laparotomies. This has the potential to reduce morbidity, and improve efficacy and efficiency for liver cancer treatment.