Enabling Technology for Safe Robot-assisted Surgical Micromanipulation

项目概要/摘要 这笔赠款的目标是开发使能技术，以解决显微外科手术的基本限制 特别注重为玻璃体视网膜外科医生提供协调的双边援助。视网膜静脉 闭塞（RVO）是第二常见的威胁视力的视网膜血管疾病，没有 持续成功的临床治疗可直接解决闭塞问题。一种战略方法，即 特别适合机器人辅助的方法是用微型插管对闭塞的视网膜静脉进行插管，并 注射溶凝剂。由于人类生理限制（震颤、触觉、视觉、 压力、认知要求、不完整的感觉信息等），以及视网膜脆弱和无能力 为了再生视网膜组织，已经开发了各种针对视网膜选定方面的机器人系统 静脉插管（RVC）。然而，即使拥有所有现有的和新兴的技术进步，许多 迫切需要解决的挑战仍然是持续成功治疗的障碍。我们建议双边 具有实时多感官反馈的机器人系统，可评估位于的多个仪器接触点 眼睛内部和外部。我们的双边系统将增强视网膜和巩膜的安全性，提高比率 RVC 的成功，减少对插管和静脉的作用力，减少对人类精神和身体的要求， 并允许外科医生提高运动精度，以实现更先进的外科手术 双边操纵。 为了证明双侧机器人辅助视网膜插管术是可能且安全的假设，我们提出 以下具体目标：（1）演示协调位置/力混合控制算法，以实现实时 安全双侧机器人辅助玻璃体视网膜显微手术巩膜切开术的时间感觉运动能力：实时 巩膜切开术的感觉运动能力将被独特地用于通过机器学习来控制机器人 自适应学习从用户行为到巩膜力/位置的非线性映射并预测的方法 不安全的动作； (2) 演示用于实现实时传感运动的位置/力输入控制算法 工具尖端的功能可实现安全的双边机器人辅助静脉插管：实时工具尖端与组织的交互 基于观察用户行为的力传感和非线性机器人控制算法将用于控制 工具尖端位置和力量，并防止在 RVC 期间进入视网膜下区域； (3) 展示和 在体内动物模型中使用 SHER 评估双边 RVC：实时、位置/力混合控制算法 基于双点（工具轴和尖端）信息融合将为手术提供感觉运动指导 RVC 期间的机动。在临床实际条件下，体内统计显着结果将证明 我们的方法的可行性。这种高度创新的系统具有扩展的协调双手功能 将使我们能够进一步提高 RVC 的安全性和可靠性，并使该技术进入临床前准备阶段。

Project Summary / Abstract The goal of this grant is to develop enabling technology to address fundamental limitations in microsurgery with a specific focus on developing coordinated bilateral assistance for the vitreoretinal surgeon. Retinal vein occlusion (RVO) is the second-most-prevalent vision threatening disease of retinal blood vessels, with no consistently successful clinical treatments to directly resolve the occlusion. A strategic approach, that is particularly amenable to robotic assistance, is to cannulate the occluded retinal vein with a micro-cannula and to inject a clot-dissolving agent. Due to human physiological limitations (tremor, tactile perception, visualization, stress, cognitive requirements, incomplete sensory information, etc.), as well as retinal fragility and the inability to regenerate retinal tissue, various robotic systems have been developed that target select aspects of retinal vein cannulation (RVC). However, even with all present and emerging technological advances, a number of imminently solvable challenges remain as barriers to consistently successful treatment. We propose a bilateral robotic system with real-time multisensory feedback that assesses multiple points of instrument contact located both inside and outside of the eye. Our bilateral system will enhance retina and sclera safety, increase the rate of RVC success, diminish forces on the cannula and vein, reduce the human mental and physical requirements, and allow the surgeon enhanced motion precision to enable more advanced surgical procedures benefitted by bilateral manipulation. To prove the hypothesis that bilateral robot-assisted retinal cannulation is possible and safe, we propose the following specific aims: (1) Demonstrate coordinated position/force hybrid control algorithms for enabling real- time sensorimotor capabilities at sclerotomy for safe bilateral robot-assisted vitreoretinal microsurgery: real-time sensorimotor capabilities at the sclerotomy will be uniquely used to control the robots through a machine learning method that adaptively learns a nonlinear mapping from user behavior to sclera-force/position and predicts unsafe motions; (2) Demonstrate position/force-input control algorithms for enabling real-time sensorimotor capabilities at the tool-tip for safe bilateral robot-assisted vein cannulation: real-time tool-tip-to-tissue interaction force sensing and non-linear robot control algorithms based on observing user behavior will be used to control the tool-tip position and force and to prevent entry into subretinal areas during RVC; (3) Demonstrate and evaluate bilateral RVC using SHER in animal model in vivo: real-time, position/force hybrid control algorithms based on dual-point (tool-shaft and tip) information fusion will provide sensorimotor guidance of surgical maneuvers during RVC. Statistically significant results in vivo, in clinically realistic conditions will demonstrate the feasibility of our approach. This highly innovative system with expanded coordinated bimanual capabilities will allow us to further increase the safety and reliability of RVC and move the technology to preclinical readiness.