Robot-Enabled Natural Orifice Prostatectomy

项目概要/摘要： 本计画的目的是建立一个手持式的内视镜经尿道根治手术机器人 直肠切除术。新机器人将通过内窥镜部署针头大小的手臂，用于独立组织 操作、激光瞄准和可视化，从而能够切除前列腺和重建前列腺。 临床意义来自（1）大量患者可能受益（1/7的男性将有 前列腺癌在他们的生活中;在美国每年有161，000例新病例;在美国每年有90，000例手术）， （2）目前手术方法的高发病率（70%阳萎，21%失禁，39%需要 随后进行干预以解决并发症，死亡率为1/5000）。我们假设 降低阳痿、尿失禁和并发症发生率的关键是将对脆弱组织的破坏降至最低 前列腺周围，特别是在前列腺外部运行的神经血管束， 勃起功能和外括约肌，使勃起。然而目前的手术技术 前列腺从腹部，因此需要大的解剖结构，围绕前列腺在- 包括盆内筋膜和前列腺韧带，以及神经血管束的操作和牵开。 相比之下，我们提出了一种新的方法，通过尿道从前列腺内部到达前列腺， 由通过内窥镜递送的针大小的触手状机器人操纵器实现，以实现基于激光的 切除和灵巧的重建缝合。我们假设这样的系统会改善功能- 来降低并发症的发生率，提供了一个更少的侵入性的方法来进行前列腺手术。 我们新机器人的创新之处在于能够通过内窥镜输送针头大小的机械臂。他们 是由伸缩的弯曲的弹性管组成的通过轴向旋转这些管并伸缩地延伸 我们的机器人将在内窥镜的尖端为外科医生提供两个小的触手状手臂。一个臂 将携带一个用于切割的钬激光纤维，另一个将使组织收缩，两者将共同工作， 进行重建手术。这是第一个提供双手灵活性的手持式机器人系统。它将 能够在像尿道一样小的管腔内进行扩张，这是一项重大的技术创新， 在未来的许多其他手术环境中。 我们的方法包括三个具体目标。目标1解决了一个可消毒的，手- 手持机器人系统，适用于现实世界手术室的工作流程。目标2侧重于设计控制器， 中心管操纵器，其尖端具有新颖的针和抓紧器， 切除术）。Aim 3由体模、离体动物组织和尸体组成 实验性验证我们新的经尿道根治性尿道切除术方法的研究， 质量通过医学成像和重建质量通过胶体测试。

Project Summary/Abstract: The objective of this proposal is to create a hand-held surgical robot for endoscopic transurethral radical prostatectomy. The new robot will deploy needle-sized arms through the endoscope, for independent tissue manipulation, laser aiming, and visualization, enabling resection of the prostate and reconstructive suturing. Clinical significance comes from (1) the large number of patients who could benefit (1 in 7 men will have prostate cancer in their lives; 161,000 new cases per year in the USA; 90,000 surgeries per year in the USA), and (2) the high morbidity of current surgical approaches (70% impotence, 21% incontinence, with 39% requiring a subsequent intervention to address complications, and a 1 in 5000 mortality rate). We hypothesize that the key to reducing rates of impotence, incontinence, and complications is minimal disruption to the delicate tissues surrounding the prostate, especially the neurovascular bundles that run on the outside of the prostate and control erectile function and the external sphincter that enables continence. Yet current surgical techniques approach the prostate from the abdomen, and thus require large dissection of the structures that surround the prostate in- cluding endopelvic fascia and prostatic ligaments, and manipulation and retraction of the neurovascular bundles. In contrast, we propose the novel approach of reaching the prostate from within, through the urethra, which is enabled by needle-size, tentacle-like robot manipulators delivered through an endoscope, to enable laser-based resection and dexterous reconstructive suturing. We hypothesize that such a system will improve functional out- comes and reduce complication rates, providing a much less invasive approach to performing prostate surgery. The innovation of our new robot is the ability to deliver needle-sized robotic arms through an endoscope. They are made up of telescoping, curved, elastic tubes. By axially rotating these tubes and telescopically extending them, our robot will provide the surgeon with two small tentacle-like arms at the tip of the endoscope. One arm will carry a holmium laser fiber for cutting, the other will enable tissue retraction, and both will work together to perform reconstructive suturing. This is the first hand-held robotic system to provide two-handed dexterity. It will enable suturing within a lumen as small as the urethra, a major technical innovation that we expect to be useful in many other surgical contexts in the future. Our approach consists of three Specific Aims. Aim 1 addresses the mechanical design of a sterilizable, hand- held robotic system suitable for the workflow of a real-world operating room. Aim 2 focuses on designing con- centric tube manipulators with novel needles and graspers at their tips that enable reconstructive suturing (anas- tomosis) from within the lumen to be repaired. Aim 3 consists of phantom, ex vivo animal tissue, and cadaver studies to experimentally validate our new transurethral approach to radical prostatectomy, evaluating resection quality via medical imaging and reconstruction quality via fluid testing.