Reaching inaccessible anatomy percutaneously via multi-lumen steerable needles

描述(申请人提供)：本方案的目标是开发能够控制弯曲路径穿过软组织和开放或充满液体的腔的多腔可控针头。预弯曲的管腔或管子以可伸缩的方式嵌套在彼此之间，从而能够控制开放腔中针的轴形状和曲率。我们的针还将利用尖端力量进行转向，动态修改其通过软组织的向前切割轨迹。这项工作的广泛和长期目标是创造一种(1)比现有针更准确，(2)比现有针更灵巧的针。准确性是至关重要的，因为几乎所有基于针头的干预措施(活检、治疗提供等)都有效。与针尖放置在所需目标的精确度密切相关。增强的灵活性使针头可以到达以前无法触及的位置，这将使全新的微创经皮治疗成为可能。具体地说，我们预见了在肺癌治疗、脑深部刺激和前列腺近距离治疗中令人信服的应用--这些领域存在解剖障碍，需要针头在弯曲的轨迹中移动。这项研究与美国国立卫生研究院改善公众健康的使命直接一致；我们的新型多腔可控针头将能够以微创、经皮途径接触到以前无法达到的临床目标，用于活检、局部药物注射、辐射剂量输送、外科干预和其他程序。本研究的具体目标是：(1)多腔可转针的设计和建模，(2)开发仿真和规划软件，(3)构建能够对多腔可转针进行机器人控制的综合临床前试验台。用于实现这些目标的方法将包括软组织中柔性针尖端和轴轨迹的运动学和梁力学模型、基于优化的运动规划技术和有限元模拟。我们将评估我们在体模和体外组织中开发的新设备和方法，以确定该方法的可行性。与泌尿外科和心胸外科的临床合作者合作，我们将开发一种考虑到相关临床限制和目标的系统，为未来的动物、身体和人类研究铺平道路。综上所述，我们提出了一种结合机械工程、计算机科学和生物力学建模的多学科努力，以设计和开发硬件和软件，这些硬件和软件将显著增加对人体内许多临床重要部位的微创访问。 与公共卫生相关：我们将开发能够在人体内控制曲线轨迹的多腔可控针头。这些针将在图像引导下提高针尖放置的准确性，从而提高各种针基干预的有效性。它们还将使外科手术工具能够绕过障碍，达到以前无法触及的临床目标，从而实现全新的经皮手术。

DESCRIPTION (provided by applicant): The objective of this proposal is to develop multi-lumen steerable needles capable of controllable curved paths through both soft tissues and open or liquid-filled cavities. The pre-curved lumens, or tubes, are nested within each other in a telescoping fashion, enabling control of the needle's shaft shape and curvature in open cavities. Our needles will also harness tip forces for steering, dynamically modifying their forward cutting trajectory through soft tissues. The broad, long-term objective of this work is to create a needle that is (1) more accurate than existing needles, and (2) more dexterous than existing needles. Accuracy is essential, because efficacy in nearly all needle-based interventions (biopsy, therapy delivery, etc.) is strongly correlated to the accuracy with which the needle tip is placed at the desired target. Enhanced dexterity allows the needle to reach previously inaccessible locations, which will enable entirely new minimally invasive percutaneous treatments. Specifically we foresee compelling applications in lung cancer treatment, deep brain stimulation, and prostate brachytherapy - areas where there are anatomical obstacles that require the needle to maneuver through curved trajectories. This research directly aligns with NIH's mission to improve public health; our new multi-lumen steerable needles will enable minimally invasive, percutaneous access to previously unreachable clinical targets for biopsy, local drug injection, radiation dose delivery, surgical interventions, and other procedures. The specific aims of this research are to (1) Design and model multi-lumen steerable needles, (2) Develop simulation and planning software, (3) Construct an integrated pre-clinical testbed capable of robotically control- ling multi-lumen steerable needles. The methods used to achieve these aims will include kinematic and beam mechanics models for the tip and shaft trajectories of flexible needles in soft tissues, optimization-based motion planning techniques, and finite element simulation. We will evaluate the new devices and methods we develop in phantom and ex vivo tissues to establish the feasibility of the approach. Working with clinical collaborators in urology and cardiothoracic surgery we will develop a system that accounts for relevant clinical constraints and objectives, paving the way for future animal, cadaver, and human studies. In summary, we propose a multidisciplinary effort combining mechanical engineering, computer science, and biomechanical modeling to design and develop hardware and software that will dramatically increase minimally invasive access to many sites of clinical importance within the human body. PUBLIC HEALTH RELEVANCE: We will develop multi-lumen steerable needles capable of controllable curved trajectories in the human body. These needles will enhance needle tip placement accuracy under image guidance, thereby increasing the efficacy of a wide variety of needle-based interventions. They will also enable entirely new percutaneous procedures by endowing surgical tools with the ability to maneuver around obstacles to reach previously inaccessible clinical targets.