Image Guided Robotic Nephron-Sparing Surgery

项目摘要 通过保留肾单位（“部分”）手术干预期间保留肾功能的重要性 “肾切除术”）外科技术近来已经获得了相当多的和日益增长的认可。肾脏总 切除（“根治性肾切除术”）永久损害肾功能，并导致发病率增加， 死亡率，对患者的长期生活质量产生重大负面影响。相反，肾部分切除术 通过保留最大量的健康肾组织来改善长期结果。然而，最低限度 很少尝试侵入性肾部分切除术，因为其完成极具挑战性。的 外科医生必须根据以下因素做出关键的术中决定（这可能意味着患者的生命或死亡）： 不精确的心理推断和登记的三维解剖关系。外科医生必须 查看一系列2D术前图像并构建患者解剖结构的心理3D模型。他/她必须 术中猜测该记住的解剖图应该如何配准到患者。固有的 该过程中的不精确性阻碍了许多外科医生尝试微创部分肾切除术， 因为阳性边缘（或对内部肾脏结构的无意损伤）是灾难性的结果，而 采用大的阴性边缘会使肾部分切除术的目的失败。 我们的总体目标是创建一个图像引导的手术系统，使定位，解剖， 关键血管和器官结构的隔离，以及正确的边缘选择，更容易和更准确 对于外科医生（并且因此对于患者来说手术更安全和更有效），从而增加了 能够采用保留肾单位技术的外科医生和医院数量。为了实现这一目标，我们的具体 本提案的目的是检验图像引导可以增加准确性和/或时间的假设， 手术的效率。为了验证这一假设，我们提出了三个具体目标：目标1实现图像 在达芬奇手术机器人平台上进行指导。目标2使用以下方法解决了广泛的体模验证研究 解剖学上精确的合成器官，具有逼真的材料特性。Aim 3由体内人 受试者初步研究我们称之为“旁观者研究”，因为它可以在对人类基本上零风险的情况下实现 科目该R 01的终点将是一个经过充分验证的系统，以及必要的实验数据， 一项大规模的临床疗效比较研究。这项研究将能够进行后不久， 由于da芬奇机器人的广泛可用性，以及所有外科医生或 医院必须参与的是机器人本身-没有额外的设备或基础设施 必须作出改变。

Project Summary The importance of preserving renal function during surgical interventions through nephron-sparing (“partial nephrectomy”) surgical techniques has garnered considerable and growing recent recognition. Total kidney removal (“radical nephrectomy”) permanently compromises renal function and leads to increased morbidity and mortality, with substantial negative impact on long-term patient quality of life. In contrast, partial nephrectomy improves long-term outcomes by sparing a maximal amount of healthy kidney tissue. However, minimally invasive partial nephrectomy is rarely attempted because it is extremely challenging to accomplish. The surgeon must make critical intraoperative decisions (which can mean life or death for the patient), based on imprecisely mentally inferred and registered three-dimensional anatomical relationships. The surgeon must view a series of 2D preoperative images and build a mental 3D model of patient anatomy. He/she must then intraoperatively guess how this remembered anatomical map should be registered to the patient. The inherent inaccuracies in this process prevent many surgeons from attempting minimally invasive partial nephrectomy, since positive margins (or inadvertent damage to internal kidney structures) are disastrous outcomes, while taking a large negative margin defeats the purpose of the partial nephrectomy procedure. Our overall goal is to create an image-guided surgical system that makes localization, dissection, and isolation of critical vascular and organ structures, as well as correct margin selection, easier and more accurate for the surgeon (and thus the procedure safer and more effective for the patient), thereby increasing the number of surgeons and hospitals able to adopt nephron sparing techniques. Toward this goal, our specific objective in this proposal is to test the hypothesis that image guidance can increase the accuracy and/or time- efficiency of the surgery. To test this hypothesis, we propose three Specific Aims: Aim 1 implements image guidance on the da Vinci surgical robot platform. Aim 2 addresses extensive phantom validation studies using anatomically accurate synthetic organs with realistic material properties. Aim 3 consists of an in vivo human subject pilot study we call a “bystander study” because it can be achieved with essentially zero risk to human subjects. The endpoint of this R01 will be a fully validated system, and the necessary experimental data to power a large-scale clinical comparative efficacy study. This study will be able to take place soon after the conclusion of this R01, due to the wide availability of the da Vinci robot, and the fact that all a surgeon or hospital must have to participate is the robot itself – no additional pieces of equipment or infrastructural changes will be necessary.