A Navigational System for Endoscopic Kidney Stone Surgery

项目摘要/摘要 在内窥镜肾结石手术中实现无结石状态的重要性由 指甲手术后残留碎石，重复结石手术的比率高。具体地说，残留的石头 碎片可能导致梗阻、疼痛、肾脏损伤和反复感染。成功的内窥镜结石 手术需要外科医生对整个肾脏收集系统进行可视化，并在手术期间定位所有肾结石 治疗。几个挑战可能导致结石治疗不完全，包括结石能见度不足和 在肾脏中导航有困难。具体地说，血液或碎片经常会掩盖本已有限的 内窥镜结石手术中的视野。此外，在采集系统中成功导航 要求外科医生从术前2D轴位在脑海中创建患者解剖的3D模型 计算机断层扫描(CT)图像。此外，在治疗过程中，结石可能碎裂和分散。 在整个采集系统中，进一步复杂化了术中追踪。尽管技术上的限制 内窥镜也可能影响肾结石的外科治疗结果，这是内窥镜结石治疗的上述局限性。 防止许多外科医生达到完全无结石状态。 我们的总体目标是创建一个导航系统，使结石在肾脏内进行定位和跟踪 采集系统对外科医生来说更容易、更准确。为了这个目标，我们在这个方面的具体目标 建议对内窥镜结石手术中导航系统可以改善结石的假设进行检验。 免费率，减少反复手术或残留碎片的并发症。为了检验这一假设，我们 提出两个具体目标：目标1涉及开发一种自动的、实时的分割和跟踪 内窥镜结石手术中的肾结石系统。Aim 2集成了一张3D导航图 内窥镜手术中的系统解剖和肾结石定位。此R21的端点将是一个完整的 经验证的内窥镜结石手术导航系统和必要的实验数据 大规模、多中心临床试验。因为我们的导航系统只需要软件集成即可 目前的内窥镜手术摄像机，所有现有的内窥镜手术系统原则上都可以立即 从这个项目的成果中获益。通过这种方式，我们相信我们项目的成功将促进改进 结石清除率和减少重复干预或并发症，使患者、外科医生和社会受益。

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.