Vitreoretinal Surgery via Robotic Microsurgical System with Image Guidance, Force Feedback, Virtual Fixture, and Augmented Reality

通过具有图像引导、力反馈、虚拟夹具和增强现实功能的机器人显微手术系统进行玻璃体视网膜手术

• 批准号: 10582637
• 负责人: JACOB ROSEN
• 金额: $ 40.18万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10582637
• 关键词: 3-Dimensional; Abate; Affect; Age related macular degeneration; Aging; Anatomy; Augmented Reality; Biological; Blindness; Cannulations; Cataract Extraction; Clinical; Complete Blindness; Complex; Data; Dedications; Detection; Development; Diabetes Mellitus; Diabetic Retinopathy; Disease; Dissection; Engineering; Ensure; Environment; Epidemic; Epiretinal Membrane; Evaluation; Excision; Eye; Eye Surgeon; Failure; Family suidae; Feedback; Foundations; Functional disorder; Funding; Goals; Grant; Hand; Health; Human; Iatrogenesis; Image; Individual; Intervention; Location; Mechanics; Membrane; Microscope; Microsurgery; Modeling; Motion; Motivation; Movement; Operative Surgical Procedures; Optical Coherence Tomography; Outcome; Pathology; Patients; Perception; Performance; Physiological; Population; Procedures; Process; Protocols documentation; Psyche structure; Raven; Research; Resolution; Retina; Retinal Diseases; Retinal Perforations; Robot; Robotics; Safety; Scanning; Science; Series; Speed; Structure; Structure of central vein of the retina; Surgeon; Surgical Instruments; Surgical complication; System; Tactile; Time; Tissues; Translating; Uncertainty; United States National Institutes of Health; Vision; Visual; Visual impairment; Visualization; Vitrectomy; Work; auditory feedback; cognitive load; cost; design; experience; fabrication; force feedback; haptic feedback; human tissue; image guided; improved; innovation; interest; lens; meter; microscopic imaging; minimally invasive; multimodality; new technology; open source; prototype; robot control; robot interface; robotic system; sensory feedback; subretinal injection; success; surgery outcome; teleoperation; tool; virtual; virtual reality simulator; visual feedback

PROJECT SUMMARY/ABSTRACT The aims of the present proposal are to extend our work with the Intraocular Robotic Interventional and Surgical System (IRISS) and augment it for teleoperated vitreoretinal surgery. Although novel technologies such as intraoperative optical coherence tomography (i-OCT) have been developed, vitreoretinal surgeons still lack critical information during surgery (e.g., the distance between pre-retinal membrane and retina) due to inadequate display and feedback. In addition, physiological capabilities are a limiting factor because the retina is one of the smallest and most delicate tissues of the human body. The rate of surgical failure in complex retinal cases remains high (10–15%) due to the limits of current surgical capabilities, thereby condemning these patients to blindness [1-3]. Our group has developed the IRISS [4-10] through a combination of internal funding and a recent R21 grant (NIH/R21EY024065). This support enabled our group to develop the IRISS platform to perform fully automated cataract surgery on ex-vivo pig eyes. We have also demonstrated the ability of the IRISS to perform safe- motion guidance for lens removal based on per-operative, real-time anatomical detection, and teleoperated capabilities for vitreoretinal maneuvers, including retinal vein cannulation and core vitrectomy [4]. Furthermore, Raven II, an open-source surgical robotics system [11-22], was co-developed by Rosen over the past 16 years for general minimally invasive surgery. In the present study, the surgical cockpit of the Raven II system will serve as the foundation of the user interface for the improved robotic surgical system. The accumulated experience of our group through this previous work will guide the proposed research effort from the stringent clinical requirements to the design, development, and evaluation of the proposed system. The present study is composed of three independent, parallel tracks. First, the mechanical design and assembly of the robotic surgical system will be improved to achieve tool-tip positional precision of 5 µm, approximately ten times more precise than a human surgeon [23]. Second, we will enhance the surgeon's abilities in sensing and interpreting anatomical details during retinal manipulation by applying high-resolution (10 µm), real-time intraoperative i-OCT scans to detect anatomical features critical to specific vitreoretinal procedures. Third, surgical features of interest will be presented to the surgeon via a human–robot surgical cockpit that provides innovative 3D, augmented-reality visualization and auditory and haptic feedback. Each aim will be assessed by a series of evaluation protocols to ensure their success. The safety and efficacy of the system will also be compared with and without the proposed improvements (robotic control, enhanced sensing, and augmented feedback) on a virtual reality simulator in addition to phantom and biological eye models chosen to best assess surgical outcome. It is important to note that while the ultimate goal is the integration of all three aims, their development remains independent and success or failure in one does not affect the outcome of another. We hypothesize that a surgeon–robot surgical system that incorporates enhanced sensing and feedback to enrich the surgeon's perception and interpretation of anatomical details will improve surgical safety and reduce the rate of surgical complications to improve health outcomes and abate the costs associated with surgical complications.

项目概要/摘要 本提案的目的是扩展我们在眼内机器人介入和治疗方面的工作 手术系统（IRISS）并增强其用于远程玻璃体视网膜手术。虽然新技术 例如术中光学相干断层扫描（i-OCT）已经开发出来，玻璃体视网膜外科医生仍然 由于以下原因，在手术期间缺乏关键信息（例如视网膜前膜和视网膜之间的距离） 展示和反馈不足。此外，生理能力也是一个限制因素，因为视网膜 是人体最小、最脆弱的组织之一。复杂手术失败率 由于目前手术能力的限制，视网膜病例仍然很高（10-15%），因此谴责 这些患者导致失明[1-3]。 我们小组通过内部资金和最近的 R21 拨款相结合开发了 IRISS [4-10] (NIH/R21EY024065)。这种支持使我们的团队能够开发 IRISS 平台来执行完全自动化的操作 对离体猪眼进行白内障手术。我们还展示了 IRISS 执行安全操作的能力 基于术前实时解剖检测和远程操作的晶状体摘除运动指导 玻璃体视网膜操作的能力，包括视网膜静脉插管和核心玻璃体切除术[4]。此外， Raven II 是一个开源手术机器人系统 [11-22]，由 Rosen 在过去 16 年中共同开发 用于一般微创手术。在本研究中，Raven II 系统的手术驾驶舱将 作为改进的机器人手术系统的用户界面的基础。累计的 我们小组通过之前的工作获得的经验将指导拟议的研究工作 所提出系统的设计、开发和评估的临床要求。 本研究由三个独立、平行的轨道组成。一、机械设计与 机器人手术系统的装配将得到改进，以实现工具尖端位置精度 5 µm， 大约比人类外科医生精确十倍[23]。二是要提高手术医生的水平。 通过应用高分辨率在视网膜操作过程中感知和解释解剖细节的能力 (10 µm)，实时术中 i-OCT 扫描，检测对特定玻璃体视网膜至关重要的解剖特征 程序。第三，感兴趣的手术特征将通过人机手术呈现给外科医生 驾驶舱提供创新的 3D、增强现实可视化以及听觉和触觉反馈。每个 目标将通过一系列评估协议进行评估，以确保其成功。该药物的安全性和有效性 系统还将比较有和没有提出的改进（机器人控制、增强传感、 除了幻眼和生物眼模型之外，虚拟现实模拟器上的反馈和增强反馈） 选择最佳评估手术结果。值得注意的是，虽然最终目标是整合 所有三个目标的发展都是独立的，其中一个目标的成功或失败并不影响 另一个的结果。 我们假设外科医生机器人手术系统结合了增强的传感和反馈 丰富外科医生对解剖细节的感知和解释将提高手术安全性并减少 手术并发症的发生率，以改善健康结果并降低与手术相关的费用 并发症。

项目成果

Automated Retinal Vein Cannulation on Silicone Phantoms Using Optical-Coherence-Tomography-Guided Robotic Manipulations.

• DOI: 10.1109/tmech.2020.3045875
• 发表时间: 2021-10
• 期刊: IEEE-ASME TRANSACTIONS ON MECHATRONICS
• 影响因子: 6.4
• 作者: Gerber, Matthew J.;Hubschman, Jean-Pierre;Tsao, Tsu-Chin
• 通讯作者: Tsao, Tsu-Chin

A Novel Tissue Identification Framework in Cataract Surgery Using an Integrated Bioimpedance-Based Probe and Machine Learning Algorithms.

使用基于生物阻抗的集成探针和机器学习算法的白内障手术中的新型组织识别框架。

• DOI: 10.1109/tbme.2021.3109246
• 发表时间: 2022
• 期刊: IEEE transactions on bio-medical engineering
• 作者: AghajaniPedram,Sahba;Ferguson,Peter;Gerber,Matthew;Shin,Changyeob;Hubschman,J-P;Rosen,Jacob
• 通讯作者: Rosen,Jacob