A Microsurgical Assistant System

描述(由申请人提供)：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，开发技术和系统，解决当前显微外科实践中的根本限制。玻璃体视网膜手术是眼科中技术要求最高的学科，解决了日益增长的需求地区普遍存在的威胁视力的问题。随着我们人口的老龄化，威胁视力的疾病将继续上升。视网膜手术目前是在手术显微镜下进行的，配备了徒手器械。限制包括有限的视觉分辨率和生理性手部震颤。这位外科医生还在为缺乏触觉反馈、接近感知和视网膜生理参数的实时感知而苦苦挣扎。将术前影像与术中观相结合，可提高手术技巧和手术效率。在目前的实践中，外科医生的人体工程学不佳会导致外科医生疲劳和潜在的残疾。所有这些因素都会延长手术时间，伴随轻度毒性，以及高于所需的并发症发生率。我们计划的方法的中心是一个连接到立体可视化子系统和一系列新型传感器、仪器和机器人设备的“外科工作站”系统。这些组件的功能分别解决了当前实践的重要局限性；它们共同提供了一个模块化、协同和可扩展的系统，使计算机接口技术和信息处理能够与外科医生合作，改善临床护理并实现新的治疗方法。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，以显著增强外科医生执行显微外科任务的能力；以及3)评估我们的系统在与三个试验床应用相关的真实幻影、身体和动物模型上改善外科医生执行现实外科任务的能力。我们选择了三种常见的威胁视力的疾病的手术治疗来为我们的研究提供特定的重点：视网膜表面的病理，内界膜的病理，以及视网膜静脉阻塞。我们建议开发的具体能力既解决了与这些程序相关的具体挑战，也适用于玻璃体视网膜手术所需的其他技术和疾病。它们的集成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。 与公共健康相关：该生物工程研究伙伴关系(BRP)解决了当前显微外科实践中的基本限制，专注于玻璃体视网膜手术，这是技术要求最高的眼科学科。开发的能力直接解决了与手术治疗三种最常见的视力丧失原因相关的挑战，随着我们人口的老龄化，这三种原因正变得越来越普遍。此外，这些能力广泛适用于其他显微外科问题，该系统将使眼科和其他显微外科学科得到进一步发展。

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.