System for Image-Guided, Minimally-Invasive Kidney Surgery

图像引导微创肾脏手术系统

• 批准号: 8246961
• 负责人: DAVID B KYNOR
• 金额: $ 25.45万
• 依托单位: CREARE, LLC
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8246961
• 关键词: Ablation; Affect; American; Anatomic structures; Anatomy; Animal Experiments; Animals; Biomedical Engineering; Blood Vessels; Cancer Control; Chairperson; Clinical; Color; Complication; Data; Detection; Development; Device or Instrument Development; Diagnosis; Dialysis procedure; Disease; Duct (organ) structure; Engineering; Evaluation; Excision; Experimental Animal Model; Face; Failure; Fibrous capsule of kidney; Generations; Goals; Government; Growth; Health system; Image; Image-Guided Surgery; Imaging Device; Imaging technology; Injury; Kidney; Kidney Failure; Knowledge; Laparoscopes; Laparoscopic Surgical Procedures; Lasers; Lead; Left kidney; Lesion; Letters; Licensing; Life; Lighting; Location; Magnetic Resonance Imaging; Malignant neoplasm of prostate; Malignant neoplasm of urinary bladder; Measurement; Measures; Medical Device; Medical Imaging; Methods; Motivation; Navigation System; Nephrectomy; Operative Surgical Procedures; Organ; Outcome; Patients; Performance; Perfusion; Persons; Phase; Positioning Attribute; Principal Investigator; Probability; Procedures; Process; Prostatectomy; Qualifying; Reliance; Renal Cell Carcinoma; Renal function; Research Design; Research Methodology; Resolution; Risk; Scanning; Series; Shapes; Simulate; Small Business Innovation Research Grant; Specific qualifier value; Speed; Surface; Surgeon; Surgical incisions; Surgical margins; System; Techniques; Technology; Time; Universities; Urologic Cancer; Urologist; Urology; Vendor; Work; base; capsule; commercialization; experience; follower of religion Jewish; image processing; improved; instrument; kidney surgery; killings; liver imaging; meetings; millimeter; millisecond; minimally invasive; mortality; neurosurgery; new technology; north shore long island; novel; operation; optical imaging; pressure; professor; prototype; public health relevance; success; technology development; tool; tumor; urinary

DESCRIPTION (provided by applicant): Approximately 54,000 Americans are diagnosed with renal cell carcinoma each year. The disease kills about 14,000 Americans each year and has the highest mortality rate of all urologic cancers (about twice the mortality rate of prostate and bladder cancer). In the past, treatment of renal cell carcinoma required surgical removal of the entire affected kidney leaving the patient at life-long risk for developing renal insufficiency or complete loss of renal function if their remaining kidney was compromised for any reason. Fortunately, recent advances in imaging have dramatically increased detection of small tumors that are amenable to local resection. As a result, surgical resection of only that portion of the kidney containing the tumor (partial nephrectomy) has become the preferred approach in many patients. This transition to less aggressive surgery has been accompanied by increased reliance on minimally-invasive, laparoscopic surgery. However, laparoscopic kidney surgery is technically demanding, primarily due to difficulties in visualizing tumor margins and navigating around anatomic structures imposed by current laparoscopic tools. As a result, the rate of significant complications (including vascular injuries and failure to obtain clear surgical margins) remains higher in laparoscopic partial nephrectomy than in comparable open procedures. The goal of this project is development of a system enabling renal surgeons to use methods previously developed for image-guided neurosurgery during laparoscopic resection of kidney lesions. These methods allow the margins of key anatomic structures (e.g., tumors, vessels, and ducts) to be superimposed onto the laparoscopic video images. During Phase I, we built a laparoscopic instrument capable of measuring the position and shape of the renal capsule during surgery. During Phase II, we will build a second-generation refined system and will evaluate the performance of the system in a series of animal experiments. We have assembled a highly qualified team for this project. The lead Creare engineers have experience in the development of laparoscopic technology and development of novel medical imaging technology. Our team also includes prominent surgeons with expertise in laparoscopic surgery, and biomedical engineers who have been pioneers in the development of image-guided surgery. PUBLIC HEALTH RELEVANCE: The goal of this project is development of a new technology to assist surgical navigation as a means of reducing complication rates and improving the outcomes of laparoscopic kidney surgery. Laparoscopic partial nephrectomy is a commonly performed procedure that offers tremendous benefits to the patient. Unfortunately, the risk of serious complications in this laparoscopic procedure remains higher than in conventional open surgery.

描述（由申请人提供）：每年约有54,000名美国人被诊断为肾细胞癌。这种疾病每年导致大约14000名美国人死亡，是所有泌尿系统癌症中死亡率最高的（大约是前列腺癌和膀胱癌死亡率的两倍）。在过去，治疗肾细胞癌需要手术切除整个受影响的肾脏，如果患者的剩余肾脏因任何原因受损，则患者终生面临肾功能不全或肾功能完全丧失的风险。幸运的是，近年来影像学的进步极大地提高了对适于局部切除的小肿瘤的检测。因此，手术切除含有肿瘤的那部分肾脏（部分肾切除术）已成为许多患者的首选方法。这种向微创手术的转变伴随着对微创腹腔镜手术的依赖。然而，腹腔镜肾脏手术在技术上要求很高，主要是由于目前的腹腔镜工具在观察肿瘤边缘和在解剖结构周围导航方面存在困难。因此，腹腔镜部分肾切除术的严重并发症（包括血管损伤和无法获得清晰的手术边缘）的发生率仍然高于类似的开放式手术。该项目的目标是开发一种系统，使肾脏外科医生能够在腹腔镜肾脏病变切除术中使用先前为图像引导神经外科手术开发的方法。这些方法允许将关键解剖结构（如肿瘤、血管和导管）的边缘叠加到腹腔镜视频图像上。在第一阶段，我们建造了一个腹腔镜仪器，能够在手术中测量肾包膜的位置和形状。在第二阶段，我们将构建第二代精炼系统，并将在一系列动物实验中评估该系统的性能。我们为这个项目组建了一支高素质的团队。Creare的首席工程师在腹腔镜技术的开发和新型医学成像技术的开发方面具有丰富的经验。我们的团队还包括在腹腔镜手术方面具有专业知识的杰出外科医生，以及在图像引导手术发展方面处于领先地位的生物医学工程师。