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

OCT 引导徒手半自动显微手术工具，用于增强视网膜电涌

• 批准号: 8303214
• 负责人: PETER LOUIS GEHLBACH
• 金额: $ 36.14万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8303214
• 关键词: Address; Blindness; Cannulas; Clinical; Clinical Research; Clinical Trials; Detection; Development; Devices; Discipline; Environment; Epiretinal Membrane; Evaluation; Eye; Family suidae; Fiber Optics; Financial compensation; Forcep; Frequencies; Goals; Hand; Hand functions; Human; Imagery; Injection of therapeutic agent; Injury; Intervention; Laboratories; Manuals; Mechanics; Membrane; Microinjections; Microscope; Microsurgery; Modeling; Modification; Motion; Movement; Natural regeneration; Needles; Operative Surgical Procedures; Ophthalmology; Optical Coherence Tomography; Optics; Oryctolagus cuniculus; Outcome; Penetration; Performance; Physiological; Positioning Attribute; Procedures; Process; Relative (related person); Retina; Retinal; Risk; Safety; Scientist; Severities; Site; Staging; Surface; Surgeon; Surgical Error; Surgical incisions; System; Techniques; Technology; Testing; Therapeutic Agents; Thick; Time; Tissues; Training; Translating; Translations; Validation; Variant; Vitrectomy; Work; base; clinically relevant; design; egg; empowered; ergonomics; experience; grasp; head-to-head comparison; improved; in vivo; instrument; motor control; optical imaging; optical sensor; practical application; tool

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.

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操作显微镜，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，包括临床科学家和玻璃体视网膜外科医生，光学设备科学家和系统集成商，以将我们实验室中现有和正在开发的技术转化为实际应用。为此，我们将在干模型和湿模型中进行生产和测试，并在体内验证拟议的仪器。 在这里，我们将建立在我们以前和正在进行的工作，在光纤成像，传感和运动检测和控制，以建立一个平台，提高外科医生的能力，以可视化光学透明组织，识别和跟踪组织边缘，保持手术位置，检测早期仪器与组织接触，并评估组织穿透深度。为了提供这些扩展功能，我们将把我们的光学传感器为基础的表面拓扑结构，运动限制和补偿技术到显微手术的指导工具，可以放置到眼睛。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靶向和干预。从最初的设计，该平台将发展成为一个紧凑，重量轻，以及符合人体工程学设计的工具，自由的手使用的显微外科医生。 三种功能性手术工具将被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能力。这些将包括一个简单的显微注射套管，将允许评估工具尖端位置，工具-视网膜接触和视网膜穿透深度，以及直接将治疗剂输送到视网膜。第二个手术功能是手术刀片，其工具轴运动和切口深度受表面拓扑结构的约束，以及用于工具引导的运动限制和补偿技术。该工具的手术目的是切开内界膜，对下层视网膜的损伤最小。用于最小化损伤的策略将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一种微型镊子，它将利用我们集成的前向共光路光学相干断层扫描功能，以帮助识别视觉上透明的手术边缘和跟踪手术进展。将使用我们实验室中使用的示范性干和湿模型以及离体猪眼模型定量评价每种独特的工具应用。在评估过程中的所有点，经验丰富的玻璃体视网膜外科医生将严格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到临床研究准备，应用。