Intrasurgical OCT Image-Guided Robot Assist Device for Partial Thickness Corneal Transplanation

术中OCT图像引导机器人部分厚角膜移植辅助装置

• 批准号: 9913524
• 负责人: Kris Hauser
• 金额: $ 18.88万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9913524
• 关键词: 3-Dimensional; Adoption; Algorithms; Allografting; Anterior; Applications Grants; Cadaver; Clinical; Complex; Computer software; Cornea; Corneal Endothelium; Custom; Development; Devices; Dissection; Endothelium; Eye; Foundations; Hand; Human; Image; Image-Guided Surgery; Imaging Techniques; Imaging technology; Immune; Intervention; Keratoplasty; Lamellar Keratoplasty; Manuals; Microscope; Microscopic; Microsurgery; Modeling; Modification; Monitor; Motion; Needles; Operative Surgical Procedures; Optical Coherence Tomography; Outcome; Patient-Focused Outcomes; Patients; Penetration; Positioning Attribute; Procedures; Public Health; Research; Research Project Grants; Risk; Robot; Robotics; Self-Help Devices; Site; Surface; Surgeon; System; Systems Integration; Techniques; Technology; Thick; Time; Tissues; Training; Transplantation Surgery; Tremor; United States National Institutes of Health; Visualization; Visualization software; arm; base; corneal epithelium; dexterity; experience; first-in-human; graft failure; image guided; imaging Segmentation; improved; in vivo; instrument; microscopic imaging; neurosurgery; novel; prevent; robot assistance; robot control; robotic system; skills; soft tissue; stereoscopic; success; surgery outcome

PROJECT SUMMARY This is an application for an Exploratory/Developmental Research Grant which brings together a team of experts in ophthalmic imaging, surgery and robotics to advance the state of the art in image-guided robotic microsurgical intervention. Corneal transplants are one of the most commonly performed allograft procedures worldwide, although there remains a substantial risk of immune rejection or graft failure. An alternative form of corneal transplantation known as Deep Anterior Lamellar Keratoplasty (DALK) has been described which solves most of the drawbacks of conventional corneal transplantation. However, this procedure requires great manual dexterity and experience because depth is difficult to assess using the standard ophthalmic surgical microscope. Even in experienced hands, DALK fails more often than not, requiring conversion to the older PKP procedure. Over the past decade, our team has become a leading academic research group applying optical coherence tomography (OCT) technology in ophthalmic microsurgery. Our current surgical microscope- integrated OCT (MIOCT) systems provide real time, in vivo microscopic imaging of the surgical field, viewed by the surgeon via a stereoscopic heads-up display or stereoscopic monitor. In the proposed project, we will leverage this state-of-the-art imaging technology to develop a robotic surgical assist device to enable microscale maneuverability to match the microscale visualization afforded by OCT. In the envisioned robotic assist device, the surgeon cooperatively guides an ergonomic tissue dissector handpiece comprising the robot arm end effector to a corneal insertion site, whereupon novel device control software will generate an optimal needle insertion trajectory using a cornea soft-tissue deformation model. Following surgeon approval of the plan, the device will automatically execute the needle trajectory. At all times, the control software will monitor needle position under MIOCT visualization (also visible to the surgeon), compensate for surgeon hand tremor, prevent penetration of the corneal endothelium, and allow for surgeon modification or termination of the procedure. The end result of this project will be a proof of concept of the component and integrated technologies required for robot-assisted DALK surgery, suitable for advancement to first-in-human trials in a subsequent project. The expected outcome of this proposal is a suite of technologies with the potential to significantly enhance ophthalmic microsurgical technique by overcoming challenges of surgical tool visualization and manipulation on the micrometer scale. These technologies will facilitate surgeon training, advance the skills of experienced surgeons, and thus potentially improve surgical outcomes for patients. Further, we believe that development and demonstration of these technologies forms a foundation for transfer to other microsurgical applications, such as neurosurgery, hand surgery, and others that may benefit from live microscopic 3D guidance using OCT as well as potentially other imaging techniques.

项目摘要 这是一份探索性/发展性研究补助金的申请， 眼科成像、手术和机器人领域的专家，推动图像引导机器人领域的最新发展 显微外科手术角膜移植是最常见的同种异体移植手术之一 尽管仍存在免疫排斥或移植失败的重大风险。的替代形式 已经描述了称为深前板层角膜移植术（DALK）的角膜移植， 传统角膜移植的大部分缺点。然而，这个过程需要大量的手工操作。 因为使用标准眼科手术显微镜难以评估深度。 即使在经验丰富的医生手中，DALK也经常失败，需要转换为旧的PKP手术。 在过去的十年里，我们的团队已经成为一个领先的学术研究小组， 相干断层扫描（OCT）技术在眼科显微手术中的应用。我们现有的手术显微镜- 集成OCT（MIOCT）系统提供手术区域的真实的实时体内显微成像， 外科医生通过立体抬头显示器或立体显示器。在拟议项目中，我们将 利用这种最先进的成像技术来开发机器人手术辅助设备， 可操作性以匹配OCT提供的微尺度可视化。在设想的机器人辅助装置中， 外科医生协作地引导包括机器人臂末端执行器的人体工程学组织解剖器手持件 从而新的装置控制软件将产生最佳的针插入 轨迹使用角膜软组织变形模型。在外科医生批准该计划后，该器械将 自动执行针轨迹。在任何时候，控制软件都将在 MIOCT可视化（外科医生也可看到），补偿外科医生的手震颤，防止穿透 角膜内皮，并允许外科医生修改或终止手术。的最终结果 该项目将是机器人辅助所需的组件和集成技术的概念验证 DALK手术，适合在后续项目中进行首次人体试验。 该提案的预期成果是一套有可能显著增强 眼科显微手术技术，克服了手术工具可视化和操作的挑战， 千分尺刻度。这些技术将促进外科医生的培训，提高经验丰富的外科医生的技能， 外科医生，从而潜在地改善患者的手术结果。此外，我们认为， 这些技术的演示为转移到其他显微外科应用奠定了基础， 神经外科、手外科和其他可能受益于使用OCT的实时显微3D引导的手术 作为潜在的其他成像技术。

项目成果

Data-Driven Modelling and Control for Robot Needle Insertion in Deep Anterior Lamellar Keratoplasty.

• DOI: 10.1109/lra.2022.3140458
• 发表时间: 2022-04
• 期刊: IEEE ROBOTICS AND AUTOMATION LETTERS
• 影响因子: 5.2
• 作者: Edwards, William;Tang, Gao;Tian, Yuan;Draelos, Mark;Izatt, Joseph;Kuo, Anthony;Hauser, Kris
• 通讯作者: Hauser, Kris