Enabling technology for image-guided robot-assisted sub-retinal injections

项目摘要 该方案的目标是设计、开发和评估一种新的临床兼容的手术平台。 以增强视网膜外科医生为视网膜下区域提供治疗的能力。高效、安全、可重现 输送方法将使干细胞、纳米颗粒和基因疗法的安全和精确输送成为可能 常见眼病，包括但不限于老年性黄斑变性(AMD)。建议数 协作式手术机器人利用4D术中光学导引的力传感仪器 相干断层成像(4D-iOCT)用于直观的外科医生-机器人-患者界面。 人们认识到，精确的手术进入视网膜下和视网膜内间隙将提供新的 对一些流行的眼病的治疗选择；AMD仍然是 老年人失明及其高昂的护理费用使其成为一种战略性的原型条件 治疗方面的进展。在过去的十年中，干细胞和基因治疗得到了广泛的探索 AMD的治疗。初步结果表明，该药物具有良好的安全性，并提示了其潜在的疗效。 两者都有。然而，将这些方法转化为临床护理标准在一定程度上受到了缺乏 方法简单、安全、可重复、有效地将完全有活性的药物输送到视网膜下腔。 通过先进的机器人技术，我们寻求安全和可靠地增强进入视网膜下空间的途径，以 在普遍存在的视网膜疾病的背景下，允许有针对性地提供新的治疗剂，例如 AMD。我们的目标是：(1)开发和评估临床兼容的协作控制机器人助手 启用精确的工具操作。增强的功能将允许精确的定向递送，适当的 视网膜下间隙中细胞和遗传物质的定位，以及提高治疗生物学的存活率 (2)开发新的路径规划功能并将其集成到工作站上，这将有助于机器人- 辅助视网膜下注射：利用术中实时3D OCT图像，我们将先前检测和跟踪 隐形视网膜下微结构，优化进场轨迹，实现安全、可控、精确 视网膜下注射进入靶区。虚拟夹具将被纳入设计，以避免危险 (3)系统集成和临床前评估：我们将制定辅助控制计划和 融合由力传感仪器捕获的工具-组织交互的工作流 OCT系统提供的信息。此外，新技术与现有外科手术的比较 在活体内的技术将被用来证明我们方法的可行性。 这一高度创新的系统将使外科医生能够在没有颤抖的情况下进行复杂的动作 具有比以前可能的更高精度的环境，并且能够检测工具到组织 以前难以察觉的相互作用。我们设想这一发展是合乎逻辑的下一步 人、机和计算机的一体化，实现了前所未有的显微外科手术。

Project Summary The goal of this proposal is to design, develop and evaluate a novel clinically compatible surgical platform for enhancing the retina surgeon's ability to provide therapy to the subretinal domain. Efficient, safe, reproducible delivery methods would enable safe and precise delivery of stem cell, nanoparticle and gene therapies for prevalent ocular diseases including but not limited to Age-related Macular Degeneration (AMD). The proposed cooperative surgical robot utilizes force-sensing instruments that are guided by 4D intraoperative Optical Coherence Tomography (4D-iOCT) imaging for intuitive surgeon-robot-patient interfaces. It is recognized that precise surgical access to the subretinal and intraretinal spaces would provide novel treatment options for a number of prevalent ocular diseases; the fact that AMD remains the leading cause of blindness in the elderly as well as its extraordinary cost of care makes it a strategic prototype condition for advances in therapy. During the last decade, stem cells and gene therapy have been extensively explored as treatments for AMD. Preliminary results indicate a promising safety profile, and suggest potential efficacy for both. However, translation of these methods into a clinical standard of care has in part, been limited by lack of a method to easily, safely, reproducibly and effectively deliver fully viable agents to the subretinal space. By advancing robotic technology, we seek to safely and reliably enhance access to the subretinal space to allow for the targeted delivery of novel therapeutic agents in the setting of prevalent retinal diseases, such as AMD. Our aims are: (1) Develop and evaluate a clinically compatible cooperative-controlled robotic assistant to enable precise tool manipulation. The enhanced functionality will allow for precise targeted delivery, proper orientation of cells and genetic cargo in the subretinal space, and enhanced survival of therapeutic biological agents; (2) Develop and integrate a novel path planning function to the workstation that will facilitate robot- assisted subretinal injections: utilizing real-time intraoperative 3D OCT images we will detect and track previously invisible subretinal microstructure, optimize approach trajectories to achieve safe, controlled and precise subretinal injections into the target space. Virtual fixtures will be incorporated into the design to avoid dangerous motions; (3) System integration and preclinical evaluation: we will develop assistive control schemes and workflow that fuse the tool-tissue interactions captured by the force-sensing instruments and the visual information provided by the OCT system. In addition, comparison of the new technology against current surgical techniques, in vivo, will be conducted to demonstrate the feasibility of our approach. This highly innovative system will enable surgeons to perform complex maneuvers in a tremor free environment with a higher level of precision than previously possible and with the ability to sense tool-to-tissue interactions that have been previously imperceptible. We envision this development as a logical next step in the integration of man, machine and computer for the performance of unprecedented microsurgical maneuvers.