Robotic Natural Orifice Skull Base Surgery

描述（由申请人提供）：本提案的目的是通过引入一种用于自然腔道颅底手术的新型机器人系统，降低颅底外科手术的侵入性并提高其安全性。尽管与高侵入性经面和经颅入路相比，鼻内入路（其中手术器械通过鼻孔和鼻腔部署到颅底）具有令人信服的患者受益，但由于当前手术器械的限制，鼻内入路仅用于一小部分病例。该系统的目的是通过一种新的手术机器人与针直径，触手状仪器来弥补这一点。它将能够沿着曲线路径运输手术工具和摄像机，并“绕角”工作（例如，使医生能够通过绕颈动脉弯曲来切除肿瘤），同时为医生提供舒适直观的控制界面，在概念上类似于达芬奇芬奇手术系统。这样一个机器人，与仪器使用同心，弯曲，弹性管，有可能深刻影响公共卫生，因为：（1）发病率很高- 15-20%的所有原发性脑肿瘤发生在垂体和1在5人将发展一个，1在120需要颅底手术（2）传统的方法是高度侵入性的-它们需要面部组织和骨骼的解构，或者开颅术和对大脑的相关创伤;以及（3）存在一种未充分利用的、但经临床证实的替代方案-鼻内途径，由于难以使用传统的外科工具来实现，该途径没有被更广泛地使用。拟议的系统将通过三个具体目标来开发。目标1涉及测量手术力和几何形状，并使用此信息与力学模型，以优化设计所提出的机器人系统。目标2致力于为外科医生开发控制、力反馈和辅助算法，以及显示内窥镜图像、配准的术前医学图像和机器人器械位置的视觉显示器。磁跟踪将实现力感测并提高手术导航的准确性。目标3包括实验设计，以评估机器人的性能，达到手术相关的位置，并在实验室环境中，在头骨幻影，并在尸体研究中去除组织。本R 01的最终目标是一个功能齐全的机器人系统，具有手术室使用所需的所有组件，以协助外科医生进行自然腔道（即经鼻）颅底手术。

DESCRIPTION (provided by applicant): The objective of this proposal is to reduce the invasiveness and increase the safety of surgical procedures at the skull base by introducing a new robotic system for natural orifice skull base surgery. Despite compelling patient benefits compared to highly invasive transfacial and transcranial approaches, the endonasal approach - in which surgical instruments are deployed to the skull base through a nostril and the nasal cavities - is only used in a small percentage of cases due to limitations in current surgical instrumentation. The proposed system aims to remedy this through a new kind of surgical robot with needle-diameter, tentacle-like instruments. It will be able to transport surgical tools and cameras along curvilinear paths and work "around corners" (e.g. enable physicians to resect tumors by curving around the carotid arteries), while providing the physician with a comfortable and intuitive control interface conceptually similar to that of the da Vinci Surgical System. Such a robot, with instruments made using concentric, curved, elastic tubes, has the potential to profoundly impact public health because: (1) incidence is high - 15-20% of all primary brain tumors occur in the pituitary and 1 in 5 people will develop one, with 1 in 120 requiring skull base surgery (>1cm tumor); (2) traditional approaches are highly invasive - they require either deconstruction of facial tissue and bone, or a craniotomy and associated trauma to the brain; and (3) there exists an underutilized, yet clinically proven alternative - the endonasal approach, which is not more widely deployed due to the difficulty of accomplishing it using conventional surgical tools. The proposed system will be developed through three Specific Aims. Aim 1 involves measuring surgical forces and geometry and using this information with mechanics models to optimally design the proposed robotic system. Aim 2 addresses developing control, force feedback, and assistance algorithms for the surgeon, together with visual displays showing endoscope images, registered preoperative medical images, and robot instrument locations. Magnetic tracking will enable force sensing and enhance the accuracy of surgical navigation. Aim 3 consists of experiments designed to evaluate robot performance in reaching surgically relevant locations, and in removing tissue in laboratory settings, in skull phantoms, and in cadaver studies. The final objective of this R01 is a fully functional robotic system with al the components necessary for operating room use, to assist the surgeon in natural orifice (i.e. transnasal) skull base surgery.