OCT-Guided Free-Hand Semi-Automated Microsurgical Tool for Enhanced Retinal Surge

描述（由申请人提供）：当代视网膜显微手术由熟练的外科医生通过手术显微镜、利用徒手技术和手动操作的精密显微仪器进行。我们组建了一个跨学科团队，包括一名临床科学家和玻璃体视网膜外科医生、一名光学设备科学家和一名系统集成商，将我们实验室现有和正在开发的技术转化为实际应用。为此，我们将生产、在干和湿模型中进行测试，并在体内验证所提出的仪器。 在这里，我们将在光纤成像、传感和运动检测与控制方面之前和正在进行的工作的基础上建立一个平台，以增强外科医生可视化光学透明组织、识别和跟踪组织边缘、保持手术位置、检测仪器与组织的早期接触以及评估组织穿透深度的能力。为了提供这些扩展功能，我们将把基于光学传感器的表面拓扑、运动限制和补偿技术整合到可以放入眼睛的显微手术引导工具中。该系统将能够进行一维实时深度跟踪、工具运动限制、运动补偿以及主动手术瞄准和干预。从最初的设计开始，该平台将发展成为一款紧凑、轻便且符合人体工程学设计的工具，供显微外科医生徒手使用。 三种功能性手术工具将集成到可视化和引导系统中，以便在工具与视网膜接触的部位提供扩展的手术功能。其中包括一个简单的显微注射插管，可以评估工具尖端位置、工具与视网膜的接触和视网膜穿透深度，以及直接将治疗剂输送到视网膜中。第二个手术功能将是手术刀片，其工具轴运动和切口深度受表面拓扑以及用于工具引导的运动限制和补偿技术的约束。该工具的手术目的是切开内界膜，同时对下面的视网膜损伤最小。最小化损伤的策略是限制自动切割深度、限制工具运动并改善工具尖端相对于视网膜表面的可视化和控制。第三种手术工具将是微型镊子，它将利用我们集成的前向共路光学相干断层扫描功能，以协助识别视觉透明的手术边缘并跟踪手术进展。每个独特的工具应用都将使用我们实验室使用的示范性干湿模型以及离体猪眼模型进行定量评估。在评估过程的各个阶段，经验丰富的玻璃体视网膜外科医生将批判性地评估并提出临床相关的工具改进和修改。最后，使用兔眼模型进行体内测试和工具验证，将用于将该技术推进临床研究和应用。

DESCRIPTION (provided by applicant): Contemporary retinal microsurgery is performed by skilled surgeons through operating microscopes, utilizing free hand techniques and manually operated precision micro-instruments. We have assembled an interdisciplinary team including a clinician scientist and vitreoretinal surgeon, an optical device scientist and a systems integrator to translate existing and developing technology in our laboratories into practical application. To this end we will produce, test in dry and wet models and validate the proposed instrument(s) in vivo. Here we will build upon our previous and ongoing work in fiber optic imaging, sensing and motion detection and control to build a platform for enhancing the surgeon's ability to visualize optically transparent tissues, to identify and track tissue edges, to maintain surgical position, to detect early instrument contact with tissue and to assess depth of tissue penetration. In order to provide these extended capabilities we will incorporate our optical sensor based surface topology, motion limiting and compensation technology into a microsurgery guidance tool that can be placed into the eye. The system will be capable of one-dimensional real-time depth tracking, limitation of tool motion, motion compensation and active surgical targeting and intervention. From initial design the platform will evolve towards a compact and lightweight as well as ergonomically designed tool for free hand use by a micro-surgeon. Three functional surgical tools will be integrated into the visualization and guidance system in order to provide extended surgical capabilities at the site of tool to retina contact. These will include a simple microinjection cannula that will allow assessment of tool tip position, tool-retina contact and depth of retinal penetration as well as to directly deliver therapeutic agents into the retina. The second surgical function will be a surgical blade with tool axis motion and incision depth constrained by surface topology as well as motion limiting and compensation technology utilized for tool guidance. The surgical objective of the tool is to incise the internal limiting membrane with minimal damage to the underlying retina. The strategy for minimizing damage will be to constrain automated cut depth, to limit tool motion and to improve visualization and control of the tool tip relative to the retinal surface. The third surgical tool will be a micro-forceps that will utilize our integrated forward directed common-path optical coherence tomography function in order to assist in identifying visually transparent surgical edges and in tracking surgical progress. Each unique tool application will be quantitatively evaluated using demonstrative dry and wet phantoms in use in our laboratory as well as the ex vivo porcine eye model. At all points in the evaluation process an experienced vitreoretinal surgeon will critically evaluate and propose clinically relevant tool refinements and modifications. Finally, in vivo testing and tool validation, using a rabbit eye model, will be used to advance the technology to a clinical research ready, application.