A Microsurgical Assistant System

描述（由申请人提供）：这个生物工程研究伙伴关系（BRP）将集中来自约翰霍普金斯大学和卡内基梅隆大学的高素质工程师、科学家和显微外科医生的努力，以玻璃体视网膜手术为重点，开发解决当前显微外科实践基本局限性的技术和系统。玻璃体视网膜手术是技术要求最高的眼科学科，在日益增长的需求中解决了普遍存在的视力威胁问题。随着我国人口的老龄化，威胁视力的疾病的发病率将继续上升。目前，视网膜手术是在手术显微镜下进行的。局限性包括视觉分辨率有限和生理性手部震颤。外科医生还与缺乏触觉反馈、近距离感知和视网膜生理参数的实时感知作斗争。术前影像与术中影像的整合将提高手术技术和效率。在目前的实践中，外科医生的不良人体工程学导致了外科医生的疲劳和潜在的残疾。所有这些因素都会导致手术时间延长、伴随的轻度毒性和高于所需的并发症发生率。我们计划的方法的中心是一个“手术工作站”系统，该系统与立体可视化子系统和一系列新型传感器、仪器和机器人设备相连。这些组件的能力分别解决了当前实践的重要限制；它们共同提供了一个模块化的、协同的和可扩展的系统，使计算机接口技术和信息处理与外科医生合作，以改善临床护理和实现新的治疗方法。我们的具体目标是：1)开发使能技术，解决图像处理和信息融合、传感和操作方面的基本限制；2)将这些组件集成到一个模块化的可扩展系统中，显著提高外科医生执行显微外科任务的能力；3)通过三个测试平台的应用，评估我们的系统在真实的幻影、尸体和动物模型上提高外科医生实际手术任务的能力。我们选择了三种常见的视力威胁条件的手术治疗，为我们的研究提供了具体的重点：视网膜表面病理、内限制膜病理和视网膜静脉闭塞。我们建议开发的具体能力既解决了与这些手术相关的具体挑战，也适用于玻璃体视网膜手术所需的其他技术和疾病。它们的整合将验证我们的整体系统方法，并为眼科应用和其他显微外科学科（如神经外科或微血管外科）的进一步发展提供基础。

DESCRIPTION (provided by applicant): This Bioengineering Research Partnership (BRP) will focus the efforts of highly qualified engineers, scientists and micro-surgeons from Johns Hopkins University and Carnegie-Mellon University to develop technology and systems addressing fundamental limitations in current microsurgical practice, using vitreoretinal surgery as our focus. Vitreoretinal surgery is the most technically demanding ophthalmologic discipline and addresses prevalent sight-threatening conditions in areas of growing need. With the aging of our population, the prevalence of sight-threatening conditions will continue to escalate. Retinal surgery is currently performed under an operating microscope with free-hand instrumentation. Limitations include limited visual resolution, and physiological hand tremor. The surgeon also struggles with a lack of tactile feedback, proximity sensing, and real-time sensing of physiological parameters of the retina. Surgical technique and efficiency would be enhanced by the integration of preoperative images with the intraoperative view. Poor ergonomics for the surgeon in current practice result in surgeon fatigue and potential disability. All of these factors contribute to extended operating times, attendant light toxicity, and higher than needed complication rates. At the center of our planned approach is a "surgical workstation" system interfaced to a stereo visualization subsystem and a family of novel sensors, instruments, and robotic devices. The capabilities of these components individually address important limitations of current practice; together they provide a modular, synergistic, and extendable system that enables computer-interfaced technology and information processing to work in partnership with surgeons to improve clinical care and enable novel therapeutic approaches. Our specific aims are 1) Develop enabling technology addressing fundamental limitations in image processing and information fusion, sensing, and manipulation; 2) integrate these components into a modular extendable system to significantly enhance surgeons' ability to perform microsurgical tasks; and 3) evaluate our systems' ability to improve surgeon performance of realistic surgical tasks on realistic phantom, cadaver, and animal models associated with three testbed applications. We have chosen surgical treatment of three common sight threatening conditions to provide specific focus for our research: pathology of the retinal surface, pathology of the internal limiting membrane, and retinal vein occlusion. The specific capabilities that we propose to develop both address the specific challenges associated with these procedures and are applicable to other techniques and diseases required of vitreoretinal surgery. Their integration will validate our overall system approach and provide a basis for further development both for ophthalmic applications and other microsurgical disciplines such as neurosurgery or microvascular surgery. PUBLIC HEALTH RELEVANCE: This Bioengineering Research Partnership (BRP) addresses fundamental limitations in current microsurgical practice, focusing on vitreoretinal surgery, which is the most technically demanding ophthalmologic discipline. The capabilities developed directly address challenges associated with surgical treatment of three of the most common causes of vision loss, which are becoming more prevalent with the aging of our population. Further, these capabilities are broadly applicable in other microsurgical problems, and the system will enable further advances both for ophthalmology and for other microsurgical disciplines.