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孔颅底手术的新型机器人系统来减少颅底手术的侵入性并提高手术过程的安全性。尽管与高度侵入性的经面和经颅入路相比，鼻内入路（通过鼻孔和鼻腔将手术器械部署到颅底）给患者带来了明显的好处，但由于当前手术器械的局限性，鼻内入路仅在一小部分病例中使用。该系统旨在通过一种新型手术机器人来解决这个问题，这种机器人具有针状、触手状的仪器。它将能够沿着曲线路径运输手术工具和相机，并在“拐角”工作（例如，使医生能够通过绕颈动脉弯曲切除肿瘤），同时为医生提供一个舒适和直观的控制界面，在概念上类似于达芬奇手术系统。这种机器人的仪器由同心、弯曲、弹性管制成，有可能对公众健康产生深远的影响，因为：(1)发病率高——所有原发性脑肿瘤中有15-20%发生在垂体，五分之一的人会患脑瘤，120人中有1人需要颅底手术（肿瘤直径1厘米）；(2)传统的方法是高度侵入性的——它们需要解构面部组织和骨骼，或者开颅并对大脑造成相关的创伤；(3)存在一种未充分利用但经临床证实的替代方法-鼻内入路，由于使用传统手术工具难以完成，因此没有得到更广泛的应用。拟议的制度将通过三个具体目标来发展。目的1包括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涉及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、注册术前医学图像和机器人器械位置的视觉显示。磁跟踪将实现力传感，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、在实验室环境中去除组织、头骨幻影和尸体研究中的性能的实验。本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（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.