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.

项目概要/摘要 内镜肾结石手术期间实现无结石状态的重要性被强调 由于索引手术后残留碎片，重复取石手术的比率很高。具体来说，残石 碎片可能导致梗阻、疼痛、肾损伤和反复感染。内镜取石成功 手术需要外科医生在手术过程中观察整个肾集合系统并定位所有肾结石 治疗。一些挑战可能会导致石材处理不彻底，包括石材可见度不足和 难以通过肾脏。具体来说，血液或碎片经常会掩盖已经有限的区域 内窥镜取石手术期间的视野。此外，成功地通过收集系统导航 要求外科医生根据术前 2D 轴向在心里创建患者解剖结构的 3D 模型 计算机断层扫描 (CT) 图像。此外，在治疗过程中，结石可能会碎裂和分散 整个收集系统，使术中跟踪进一步复杂化。尽管技术限制 范围也可能影响手术肾结石的结果，上述内镜结石治疗的局限性 使许多外科医生无法达到完全无结石的状态。 我们的总体目标是创建一个导航系统，使肾内结石定位和跟踪 采集系统对于外科医生来说更容易、更准确。为实现这一目标，我们的具体目标 该提案旨在检验这样的假设：内窥镜取石手术期间的导航系统可以改善取石效果。 免费率，减少复发手术或残留碎片引起的并发症。为了检验这个假设，我们 提出两个具体目标：目标 1 涉及开发自动、实时分割和跟踪 内镜取石手术期间的肾结石系统。 Aim 2 集成了收集的 3D 导航地图 内窥镜手术期间的系统解剖和肾结石位置。这个 R21 的终点将是一个完全 经过验证的内窥镜结石手术导航系统和必要的实验数据为 大规模、多中心临床试验。由于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，原则上所有现有的内窥镜手术系统都可以立即 受益于该项目的成果。通过这种方式，我们相信我们项目的成功将促进改进 结石清除率并减少重复干预或并发症，使患者、外科医生和社会受益。