An Active Handheld Micromanipulator

主动手持式微操纵器

• 批准号: 9111924
• 负责人: Cameron N Riviere
• 金额: $ 34.17万
• 依托单位: CARNEGIE-MELLON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-01-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9111924
• 关键词: Address; Area; Back; Cannulations; Collaborations; Custom; Development; Devices; Eye; Face; Feedback; Financial compensation; Freedom; Hand; Health; Hemorrhage; Histology; Intervention; Life; Light; Manuals; Membrane; Micromanipulation; Microscope; Microsurgery; Motion; Movement; Needles; Operative Surgical Procedures; Optics; Oryctolagus cuniculus; Otolaryngology; Outcome; Patients; Penetration; Perception; Performance; Positioning Attribute; Postoperative Period; Procedures; Public Health; Research; Research Personnel; Retina; Retinal; Retinal Hemorrhage; Retinal Perforations; Robotics; Staging; Structure; Surgeon; Surgical Instruments; Surveys; System; Tactile; Techniques; Technology; Testing; Time; Tissues; Tremor; Vision; Visual; Work; base; device Artificial lens; improved; in vivo; in vivo Model; instrument; interest; lens; medical specialties; micromanipulator; monocular; neurosurgery; novel; operation; prevent; retina blood vessel structure; tool; virtual

 DESCRIPTION (provided by applicant): Highly accurate control of movement is fundamental to the performance of microsurgery. Vitreoretinal microsurgery in particular is among the most demanding of specialties in terms of positioning accuracy, and is likely to become more so due to the increasing interest in retinal microvascular interventions. Of similar importance when dealing with delicate tissues is precise control of applied force. The lack of it leads to complications such as iatrogenic retinal breaks and hemorrhage. As a result, surveys taken to identify directions for improvement in ophthalmic procedures have indicated that both positioning accuracy and tactile (or force) perception have high importance. In order to address the need for enhanced control of movement and force in vitreoretinal microsurgery while also maintaining the natural feel, ease of use, and direct patient contact of handheld surgical instruments, our group has developed an active handheld micromanipulator known as Micron. Micron is a fully handheld system that performs active compensation of hand tremor and other erroneous motion. We have developed novel patient-specific vision-guided position-input "virtual fixtures" (like a virtual stencil) that can be used with Micron for enhanced accuracy. We have also demonstrated force control of Micron. To date, however, tests of Micron (like most of the field of vitreoretinal surgical robotics) have usually been ex vivo and greatly simplified, e.g., using retina "open-sky" rather than an eyeball. One of the main reasons for this is the great difficulty of quantitative stereo in the nonlinear optics of the eye. We address this herein with a novel monocular structured-light approach to depth sensing. At the present stage of development of Micron, the time has now come for clinically useful interventions under realistic conditions. In this project we focus on accomplishing two which have good prospects of maximizing the benefits of Micron, and then demonstrating them in vivo. Therefore, the specific aims of this proposal are as follows: 1. To develop a complete retinal vessel cannulation system and technique using Micron that is realizable in an intact eye in vivo. This procedure will utilizea position-input virtual fixture based on microscope video and structured light projected from the tool tip. Motion scaling will help guide the surgeon to the target vessel, and avoidance zones will help prevent entry into subretinal areas. Force control will help the surgeon to avoid damaging surrounding tissue while targeting the desired vessel with a microfabricated needle. 2. To develop a complete membrane peeling system and technique using Micron that is realizable in an intact eye in vivo. This virtual fixture will enhance control of position, force, and peeling velocity. 3. To demonstrate retinal vessel cannulation and membrane peeling using Micron in a rabbit model in vivo. Performance will be evaluated in terms of tremor amplitude, applied force, and operation time, and amount of intraoperative bleeding. Postoperative SD-OCT and histology will be used to assess tissue damage.

 描述(由申请人提供)：高度精确的运动控制是显微外科手术的基础。尤其是玻璃体视网膜显微外科在定位精度方面是要求最高的专业之一，而且由于人们对视网膜微血管介入治疗的兴趣日益增加，这一点可能会变得更加苛刻。在处理脆弱的组织时，同样重要的是对外力的精确控制。缺乏它会导致并发症，如医源性视网膜破裂和出血。因此，为确定眼科手术改进方向而进行的调查表明，定位精度和触觉(或力)感知都具有高度重要性。为了满足玻璃体视网膜显微手术中增强运动和力控制的需求，同时保持手持式手术器械的自然手感、易用性和与患者的直接接触，我们团队开发了一种名为Micron的有源手持式微操作器。Micron是一种完全手持的系统，可以对手部震颤和其他错误动作进行主动补偿。我们已经开发出新颖的患者专用视觉引导位置输入“虚拟固定装置”(就像虚拟模板)，可以与美光一起使用以提高精度。我们还演示了美光的武力控制。然而，到目前为止，美光的测试(就像大多数玻璃体视网膜手术机器人领域的测试一样)通常是在体外进行的，并且大大简化了，例如，使用视网膜“开阔的天空”而不是眼球。造成这一现象的主要原因之一是眼睛的非线性光学中的定量立体很难实现。我们在这里用一个 新的单目结构光深度传感方法。在美光目前的发展阶段，现在已经到了在现实条件下进行临床有用干预的时候了。在本项目中，我们重点完成了两个有很好前景的美光效益最大化的产品，并在体内进行了演示。因此，本方案的具体目标如下：1.开发一种完整的视网膜血管插管系统和技术，该系统和技术可在活体完整的眼睛中实现。该程序将利用基于显微镜视频和从刀尖投射的结构光的位置输入虚拟夹具。运动比例将有助于引导外科医生找到目标血管，而避让区域将 帮助防止进入视网膜下区域。力量控制将帮助外科医生在用微型制造的针瞄准所需血管时避免损害周围组织。2.建立一套完整的微米膜剥离系统和技术，可在活体完整的眼内实现。这种虚拟夹具将增强对位置、力和剥离速度的控制。3.利用Micron在体兔模型上进行视网膜血管插管和膜剥离。手术效果将通过震颤幅度、外力、手术时间和术中出血量进行评估。术后采用SD-OCT和组织学方法评估组织损伤程度。