ROBOTICALLY CONTROLLED INTRALUMENAL INSTRUMENTS FOR FLEXIBLE ENDOSCOPIC INTERVENTION

项目摘要/摘要 柔性内窥镜的最新改进导致了它们在微创方面的应用激增 诊断和干预。介入性肺病学已经看到了程序的显著扩展。 随着这些进步，现在可以通过支气管镜进入大、中、甚至远端呼吸道 技术。在美国，肺癌约占所有癌症死亡人数的25%， 方便、有效、完整的筛查已变得非常重要。 灵活的内窥镜干预的重大技术挑战之一是限制 内窥镜和通过工作端口的器械之间存在的运动。 器械通常与远端镜尖端有固定的方向，在大多数情况下，只能向前推进。 沿着镜尖的轴线。此外，仪器的范围灵活性和可操作性会降低。 目前，进一步限制了灵巧性。在狭窄的支气管或气管内工作会限制这种能力 准确、快速地将仪器对准病变或活检靶点。因此，程序时间 可延展、发育不良或恶性病变可不完全治疗，或周围组织 不必要地遭受创伤，仅次于范围定位的挑战。 为了应对这一持续不断的挑战，我们开发了一种手持式机器人导管 可以通过柔性支气管镜的仪器通道。该导管可容纳 仪器设备的分类，以允许机器人增强工具的铰接，本质上解放了 目前存在于范围和工具之间的行动的严格限制，并扩大其覆盖范围和 从而允许访问和治疗更远端的病理。重要的是，机器人导尿管可以 并由一只手操作，使其使用与现有的手持式柔性内窥镜直接兼容，以及 允许一名从业人员在没有额外帮助的情况下同时操作成像仪和仪器。 总体而言，该项目的目标是(1)开发和验证机器人仪器和(2)进行用户研究 该装置用于评估其在中心和外周肺通路处理可疑病例时的效果和效率 病理学。在这个项目结束时，我们的目标是拥有一个经过验证的用于临床试验的机器人仪器。 我们假设技术将继承以前的外科机器人系统的观察到的好处，即减少 手术时间，镜下导航对邻近组织的损伤更少，器械放置更准确， 增强了提供商的程序体验。在不更换内窥镜的情况下对器械进行机器人操作 将产生一种低成本的解决方案，消除专业设备、员工和设施的负担，从而 不仅是医院，还有门诊诊所，负担得起并提供机器人手术。这具有重要的意义 将机器人增强的诊断和干预的可获得性扩大到经济上的潜力 全国各地多样化和地理上面临挑战的人口。

PROJECT SUMMARY / ABSTRACT Recent improvements in flexible endoscopes have resulted in an explosion of their use for minimally invasive diagnosis and intervention. Interventional pulmonology has seen a significant expansion of procedures along with these advances, as the large, medium, and even distal airways now can be accessed via bronchoscopic technique. With primary lung cancer accounting for approximately 25% of all cancer deaths in the US, screening expediently, effectively, and completely has become of significant importance. One of the significant technical challenges with flexible endoscopic interventions is the limitation in freedom of movement that exists between the endoscope and the instruments that are passed through the working port. Instruments typically have a fixed orientation to the distal scope tip and, in most cases, only can be advanced along the axis of scope tip. Additionally, scope flexibility and maneuverability reduces with an instrument present, further limiting dexterity. Working within the narrow confines of a bronchus or trachea limits the ability to accurately and expeditiously direct instruments to lesions or biopsy targets. As a result, procedure times may be extended, dysplastic or malignant lesions can be incompletely treated, or surrounding tissues be unnecessarily traumatized secondary to challenges with scope positioning. To address this ongoing challenge with flexible endoscopy, we have developed a handheld robotic catheter that can be passed through the instrument channel of a flexible bronchoscope. The catheter accommodates an assortment of instrumentation to allow for robotically enhanced articulation of tools, in essence, liberating the rigid restrictions of movement that currently exists between scope and instrument, and expanding its reach and allowing for more distal pathology to be accessed and treated. Importantly, the robotic catheter can be held and operated by one hand, making its use directly compatible with existing handheld flexible endoscopes, and allowing a single practitioner to operate both imager and instrumentation without additional help. Overall, the Project Aims are to (1) develop and validate the robotic instrument and (2) perform a user study of the device to evaluate its efficacy and efficiency of central and peripheral lung access for addressing suspect pathologies. At the end of this project, we aim to have a validated robotic instrument for clinical trials. We hypothesize technology will inherit the observed benefits with prior surgical robotic systems, i.e., reduced procedure times, less adjacent tissue trauma from scope navigation, more accurate instrument placement, and enhanced provider procedural experience. Robotizing the instrumentation without changing the endoscope would result in a low-cost solution that removes the burden of specialty equipment, staff, and facilities, allowing not only hospitals but also outpatient clinics to afford and offer robotic procedures. This has a significant potential to expand the accessibility of robotically enhanced diagnostics and intervention to economically diverse and geographically challenged populations across the country.