Dexterous Robot-assisted trans-urethral Bladder Resection

描述（由申请人提供）：经尿道膀胱肿瘤切除术（TURBT）和病理分期均为非肌层浸润性膀胱癌的标准手术治疗，也是所有膀胱肿瘤诊断评价和进展监测的组成部分。TURBT目前使用直型电切镜和激光/烧灼环进行。TURBT的结果高度依赖于泌尿外科医生的经验和技术能力以及肿瘤的位置。由于直的手术工具无法从切口处向上弯曲到膀胱，因此前部肿瘤的精确切除特别棘手。外科医生目前依靠公众压力和电切镜倾斜来达到膀胱的正面。然而，由于脂肪层厚，这种技术在肥胖患者中的成功有限。此外，不充分的监测和肿瘤分期与误诊的肿瘤和高复发率有关。此外，由于工具的限制，肿瘤的切除是以零碎的方式进行的。假设这种方法可能有助于种植新的癌症位置，并且与使用整块切除肿瘤的标准手术实践相反。由于缺乏能够进行整块切除的工具，外科医生无法验证该假设。这项探索性生物工程研究资助（EBRG）的短期目标侧重于开发和评估新的机器人和远程操作算法，以提高膀胱监测和切除的灵活性，准确性和可靠性。本研究的具体目的是：1.设计一个快速部署的感觉和手术干预远程操纵奴隶经尿道膀胱切除术和监视，2。将该手术从机集成到具有高水平远程操纵辅助算法的远程操纵系统中，3.评价该集成系统用于经尿道膀胱切除术。这些具体目标的实现将揭示机器人辅助膀胱切除术的潜力，以提高膀胱切除术的质量和准确性，以及使用这种新技术实现整块切除的可能性。EBRG的长期目标是为患者提供一种更准确的膀胱切除和监测替代方案，从而降低误诊率，最大限度地减少再次切除的需要，并改善预后。这一长期目标符合国家卫生研究所的使命，因为它的重点是改善病人的预后，降低发病率，并为生物医学研究提供新的工具。成功完成这项拟议的研究具有预期的更广泛的影响，提供与一般经腔手术、经胃手术、经子宫手术和经肛门手术相关的手术技术。

DESCRIPTION (provided by applicant): Transurethral resection of bladder tumor (TURBT) and pathological staging are both standard surgical therapies for non-muscle invasive bladder cancer and integral parts of the diagnostic evaluation and progression monitoring of all bladder tumors. TURBT is currently performed using straight resectoscopes and laser/cautery loops. Outcomes of TURBT are highly dependent on the experience and technical ability of the urologic surgeon and the location of the tumor. Anterior tumors are especially tricky to accurately resect due to the inability of straight surgical tools to curve up from the point of enty to the bladder. Surgeons currently rely on public pressure and resectoscope tilt to reach the frontal aspects of the bladder. However this technique has limited success in obese patients due to thick fat layer. Further, inadequate surveillance and tumor staging have been associated with misdiagnosed tumors and with a high recurrence rate. In addition, due to tool limitations, resection of tumors is carried out in a piece-meal fashion. This approach is hypothesized to possibly contribute to seeding new cancer locations and is counter indicative to the standard surgical practice of using en-block resection of tumors. Surgeons cannot validate this hypothesis due to lack of tooling that enables en-block resection. The short term goals of this Exploratory Bioengineering Research Grant (EBRG) focus on developing and evaluating new robots and tele-manipulation algorithms for improving dexterity, accuracy, and reliability of bladder surveillance and resection. The specific aims of this research are: 1. Design a rapidly deployable sensory and surgical intervention telemanipulation slave for transurethral bladder resection and surveillance, 2. Integrate this surgical slave into a telemanipulation system with high level telemanipulation assistive algorithms, 3. Evaluate this integrated system for transurethral bladder resection. Fulfillment of these specific aims will shed light on the potentia of robot-assisted bladder resection for improving quality and accuracy of bladder resection and the possibility of using this new technology to enable en-block resection. The long term goal of this EBRG is to provide patients with the benefits of a more accurate alternative to bladder resection and surveillance that in turn is expected to reduce misdiagnosis rates, minimize need for re-resection, and improve prognosis. This long term goal is in accordance with the mission of the National Health Institute since it focuses on improving patient outcome, reducing morbidity, and providing new tools for biomedical research. Successful completion of this proposed research has an expected broader impact of providing surgical technologies relevant for general trans-luminal surgery, trans-gastric, trans-uterine surgery, and trans-anal surgery.