Robotic Natural Orifice Skull Base Surgery

机器人自然孔道颅底手术

• 批准号: 9066645
• 负责人: Robert James Webster
• 金额: $ 38.17万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9066645
• 关键词: Address; Algorithm Design; Algorithms; Anterior nares; Blindness; Bone Tissue; Brain; Cadaver; Caliber; Carotid Arteries; Clinic; Clinical; Complex; Complication; Craniotomy; Curette; Data; Devices; Disease; Dura Mater; Employee Strikes; Endoscopes; Excision; Face; Feedback; Forcep; Geometry; Health; Heart; Hormonal; Hospitalization; Image; Imagery; In Vitro; Incidence; Laboratories; Location; Lung; Magnetism; Measurement; Measures; Mechanics; Medical Imaging; Modeling; Motion; Nasal cavity; Navigation System; Needles; Operating Rooms; Operative Surgical Procedures; Pain; Patients; Performance; Physicians; Pituitary Gland; Pituitary Neoplasms; Primary Brain Neoplasms; Public Health; Research; Research Subjects; Resected; Robot; Robotics; Safety; Site; Skull Base Neoplasms; Surgeon; Surgical Instruments; System; Techniques; Tissues; Translating; Trauma; Tremor; Tube; Visual; Work; base; bone; clinical practice; cranium; design; design and construction; dexterity; fetus surgery; haptics; image guided; infancy; instrument; instrumentation; meningioma; novel; prevent; research study; robot control; skull base; standard of care; tool; tumor

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.

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孔口颅底手术的新机器人系统来减少颅底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（即通过鼻孔和鼻腔将手术器械部署到颅底）对患者具有显着的益处，但由于当前手术器械的限制，仅在一小部分病例中使用。所提出的系统旨在通过一种新型手术机器人来解决这个问题，该机器人具有针直径、触手状的器械。它将能够沿着曲线路径运输手术工具和摄像机，并在“拐角处”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，概念上类似于达芬奇手术系统。这种机器人配备使用同心、弯曲、弹性管制成的仪器，有可能对公众健康产生深远影响，因为：(1) 发病率高——所有原发性脑肿瘤的 15-20% 发生在垂体中，五分之一的人会患上垂体瘤，其中 120 人中就有 1 人需要进行颅底手术（>1 厘米的肿瘤）； (2) 传统方法具有高度侵入性——它们需要解构面部组织和骨骼，或者进行开颅手术以及相关的脑部创伤； (3) 存在一种未得到充分利用但经过临床证明的替代方案——鼻内入路，由于使用传统手术工具难以实现该方法，因此并未得到更广泛的应用。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，并将这些信息与力学模型结合使用，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、注册的术前医学图像和机器人器械位置的视觉显示器。磁跟踪将实现力感应并提高手术导航的准确性。目标 3 包括旨在评估机器人在到达手术相关位置以及在实验室环境、头骨模型和尸体研究中去除组织方面的性能的实验。 R01 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孔道（即经鼻）颅底手术。

项目成果

A Wrist for Needle-Sized Surgical Robots.

• DOI: 10.1109/icra.2015.7139428
• 发表时间: 2015-05
• 期刊: IEEE International Conference on Robotics and Automation : ICRA : [proceedings]. IEEE International Conference on Robotics and Automation
• 作者: York PA;Swaney PJ;Gilbert HB;Webster RJ 3rd
• 通讯作者: Webster RJ 3rd

Optimizing Design Parameters for Sets of Concentric Tube Robots using Sampling-based Motion Planning.

使用基于采样的运动计划为同心管机器人组合的设计参数。

• DOI: 10.1109/iros.2015.7353999
• 发表时间: 2015-09-28
• 期刊: Proceedings of the ... IEEE/RSJ International Conference on Intelligent Robots and Systems. IEEE/RSJ International Conference on Intelligent Robots and Systems
• 作者: Baykal C;Torres LG;Alterovitz R
• 通讯作者: Alterovitz R

Elastic Stability of Concentric Tube Robots: A Stability Measure and Design Test.

• DOI: 10.1109/tro.2015.2500422
• 发表时间: 2016-02
• 期刊: IEEE transactions on robotics : a publication of the IEEE Robotics and Automation Society
• 作者: Gilbert HB;Hendrick RJ;Webster RJ 3rd
• 通讯作者: Webster RJ 3rd

Rapid, Reliable Shape Setting of Superelastic Nitinol for Prototyping Robots.

• DOI: 10.1109/lra.2015.2507706
• 发表时间: 2016
• 期刊: IEEE robotics and automation letters
• 影响因子: 5.2
• 作者: Gilbert HB;Webster RJ 3rd
• 通讯作者: Webster RJ 3rd

An experimental feasibility study on robotic endonasal telesurgery.

• DOI: 10.1227/neu.0000000000000623
• 发表时间: 2015-04
• 期刊: Neurosurgery
• 影响因子: 4.8
• 作者: Wirz R;Torres LG;Swaney PJ;Gilbert H;Alterovitz R;Webster RJ 3rd;Weaver KD;Russell PT 3rd
• 通讯作者: Russell PT 3rd