A Navigational System for Endoscopic Kidney Stone Surgery

内窥镜肾结石手术导航系统

• 批准号: 10665184
• 负责人: Nicholas L Kavoussi
• 金额: $ 26.18万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10665184
• 关键词: 3-Dimensional; Address; Anatomy; Blood; Blood coagulation; Clinical; Complex; Computer Vision Systems; Computer software; Data; Development; Disease; Future; Goals; Grant; Image; Incidence; Injury to Kidney; Intervention; Intraoperative Complications; Kidney; Kidney Calculi; Location; Manuals; Maps; Measurement; Memory; Modeling; Monitor; Morbidity - disease rate; Multi-Institutional Clinical Trial; Obstruction; Operating Rooms; Operative Surgical Procedures; Optics; Outcome; Pain; Patients; Positioning Attribute; Postoperative Period; Prevalence; Procedures; Psyche structure; Recovery; Recurrence; Repeat Surgery; Reporting; Research; Residual state; Societies; Surgeon; System; Techniques; Technology; Testing; Time; Training; United States; Ureteral obstruction; Urinary Calculi; Urinary tract infection; Visualization; X-Ray Computed Tomography; clinical care; clinical decision support; cost; deep learning; experience; eye hand coordination; improved; indexing; kidney surgery; minimally invasive; prevent; recurrent infection; risk mitigation; statistics; success; three-dimensional modeling; three-dimensional visualization; usability; virtual

PROJECT SUMMARY/ABSTRACT The importance of achieving stone-free status during endoscopic kidney stone surgery is emphasized by the high rate of repeat stone procedures due to residual fragments after index surgery. Specifically, residual stone fragments can lead to obstruction, pain, kidney injury, and recurrent infections. Successful endoscopic stone surgery requires the surgeon to visualize the entire renal collecting system and locate all kidney stones during treatment. Several challenges can lead to incomplete stone treatment and include inadequate stone visibility and difficulty navigating through the kidney. Specifically, blood or debris can frequently obscure the already limited field of view during endoscopic stone surgery. Additionally, successfully navigating through the collecting system requires the surgeon to mentally create a 3D model of the patient’s anatomy from preoperative 2D axial computerized tomography (CT) images. During treatment, moreover, stones can fragment and disperse throughout the collecting system, further complicating intraoperative tracking. Though technical constraints of scopes may also impact surgical kidney stone outcomes, the above limitations of endoscopic stone treatment prevent many surgeons from achieving a complete stone-free status. Our overall goal is to create a navigational system that makes stone localization and tracking within the renal collecting system easier and more accurate for the surgeon. Toward this goal, our specific objective in this proposal is to test the hypothesis that a navigational system during endoscopic stone surgery can improve stone- free rates, mitigating recurrent surgeries or complications from residual fragments. To test this hypothesis, we propose two Specific Aims: Aim 1 involves the development of an automatic, real-time segmentation and tracking system of kidney stones during endoscopic stone surgery. Aim 2 integrates a 3D navigational map of collecting system anatomy and kidney stone location during endoscopic surgery. The endpoint of this R21 will be a fully validated navigational system for endoscopic stone surgery and the necessary experimental data to power a large-scale, multi-center clinical trial. As our navigational system would require only software integration to current endoscopic surgical cameras, all existing endoscopic surgical systems could in principle immediately benefit from the results of this project. In this way, we believe the success of our project will facilitate improved stone-free rates and mitigate repeat interventions or complications, benefiting patients, surgeons, and society.

项目摘要/摘要 在内窥镜肾脏石头手术期间实现无石状态的重要性是由 指数手术后残留碎片引起的重复石术率很高。具体而言，残留的石头 碎片会导致客观，疼痛，肾脏损伤和反复感染。成功的内窥镜石 手术要求外科医生可视化整个肾脏收集系统，并在 治疗。几个挑战可能导致石材处理不完整，包括石材的可见性不足和 难以通过肾脏导航。具体而言，血液或碎屑经常会掩盖已经有限的 内窥镜结石手术期间的视野。另外，成功通过收集系统导航 要求外科医生从术前2D轴向从心理上创建患者解剖学的3D模型 计算机断层扫描（CT）图像。此外，在治疗过程中，石头可以碎片和分散 通过收集系统，进一步使术中跟踪复杂化。尽管技术约束 示波器还可能影响手术肾结石的结果，上述内窥镜结石治疗的局限性 防止许多外科医生获得完整的无石状态。 我们的总体目标是创建一个导航系统，该系统在肾脏内进行石材定位和跟踪 为外科医生更容易，更准确地收集系统。朝着这个目标，我们在这方面的具体目标 提案是检验以下假设：内窥镜结石手术期间的导航系统可以改善石材 - 自由率，减轻剩余碎片的复发手术或并发症。为了检验这一假设，我们 提案两个具体目标：AIM 1涉及开发自动，实时细分和跟踪 内窥镜结石手术期间的肾结石系统。 AIM 2集成了3D导航图 内窥镜手术期间的系统解剖结构和肾结石位置。此R21的终点将是一个完全 经过验证的内窥镜结石手术和必要的实验数据的导航系统为A供电 大规模的多中心临床试验。由于我们的导航系统只需要软件集成到 当前的内窥镜外科摄像机，所有现有的内窥镜外科手术系统原则上都可以立即 从该项目的结果中受益。这样，我们相信我们项目的成功将有助于改善 无石费率并减轻重复干预或并发症，使患者，外科医生和社会受益。