Robotic Natural Orifice Skull Base Surgery

描述(申请人提供)：这项建议的目标是通过引入一种新的用于自然开口颅底手术的机器人系统来减少颅底手术的侵袭性并增加手术的安全性。尽管与高侵入性的经面和经颅入路相比，鼻内入路给患者带来了极大的好处，但由于目前手术器械的局限性，鼻内入路--手术器械通过鼻孔和鼻腔部署到颅底--只在一小部分病例中使用。拟议的系统旨在通过一种新型的外科机器人来弥补这一点，这种机器人带有针头直径、触手状的器械。它将能够沿曲线路径运送手术工具和相机，并在拐角处工作(例如，使医生能够通过弯曲颈动脉来切除肿瘤)，同时为医生提供概念上类似于达芬奇手术系统的舒适和直观的控制界面。这种机器人的器械是由同心、弯曲、弹性管制成的，它有可能深刻影响公众健康，因为：(1)发病率很高--所有原发脑瘤的15-20%发生在脑下垂体，每5个人中就有1个人会患上脑肿瘤，每120人中就有1人需要进行颅底手术(1厘米肿瘤)；(2)传统的手术方式是高度侵入性的--它们要么需要破坏面部组织和骨骼，要么需要开颅手术，并伴随着脑部创伤；以及(3)有一种未得到充分利用但已被临床证明的替代方法--鼻腔入路，由于使用传统手术工具难以实现，该入路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包括测量手术力和几何形状，并使用这些信息和力学模型来优化设计拟议的机器人系统。目标2介绍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可视显示。磁力跟踪将使力感应成为可能，并提高手术导航的准确性。Aim 3由实验组成，旨在评估机器人在到达手术相关位置、在实验室环境中移除组织、在头骨幻影中和在身体研究中的性能。该R01的最终目标是一个全功能的机器人系统，具有手术室使用的所有必要组件，以帮助外科医生进行自然开口(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.