Image-registered, Hand-held, Concentric Tube Robot for Percutaneous Treatment of Calculi

摘要 经皮肾镜取石术(PCNL)缺乏足够的灵活性 通过单个插入端口访问鹿角和复杂的石头，因此需要多个 程序或创建几个通道来处理整个结石。多道程序或通道 会增加实质损伤、失血、并发症发生率和医疗费用。因此，有一个 改进现行PCNL方法的必要性--加强对大肾镜的接触 和复杂的结石在骨盆肾盏解剖通过最佳端口。我们的长期目标是开发一种 机器人内窥镜，可以通过单个插入端口访问整个结石，并精确引导 最大限度地减少并发症。这笔赠款的目标是通过设计和实施 研制了一种带有位置传感器的图像配准手持式同心管机器人， 微型纤维内窥镜和激光消融光纤。为了最大限度地减少创建的区域数量，我们还将开发 计算CTR“最佳”穿刺点和期望轨迹的优化算法。这个 这项拟议研究的基本原理是，CTR沿着期望的轨迹插入，通过 最佳端口将使泌尿科医生能够通过单一通道安全地接触到整个结石，从而 确保结石完全排出，同时将对肾实质的损害降至最低。此外， 导航系统将有助于在3个维度上可视化和定位石头，从而提供增强的 深度知觉与标准2D投影透视相比。我们计划通过以下方式实现目标 追求以下具体目标：1)研制一种带有位置传感器的手持CTR装置 覆盖整个花瓣并输送激光纤维。我们还将开发一种算法来评估最优 穿孔位置，以便能够接触到整个石头，同时最大限度地提高CTR的灵活性。2)发展 手术导航软件，将诊断CT和术中跟踪的超声图像融合到 实时可视化CTR和邻近解剖结构。3)验证CTR设备和导航系统 体外肾组织和猪模型。这项拟议的研究具有重要意义，因为它将使 结石排净率，同时降低PCNL手术的并发症发生率。建议数 研究是创新的，因为它建立在最先进的CTR技术、运动规划和导航的基础上 算法和混合现实可视化方式，使泌尿科医生能够准确和安全地瞄准肾脏 PCNL术中结石。

ABSTRACT Percutaneous Nephrolithotomy (PCNL) suffers from lack of sufficient dexterity of the nephroscope to access stag horn and complex stones through a single insertion port, therefore necessitating multiple procedures or creation of several access tracts to treat the entire stone. Multiple procedures or access tracts can increase parenchyma damage, blood loss, complication rates and healthcare costs. Therefore, there is a need for improving the current method of performing PCNL by enhancing access of the nephroscope to large and complex stones in the pelvicalyceal anatomy through an optimal port. Our long-term goal is to develop a robotic endoscope that can access the entire stone through a single insertion port with accurate guidance to minimize complications. The objective of this grant is to improve access to the stone by designing and developing an image-registered hand-held concentric tube robot (CTR) instrumented with a position sensor, mini fiberscope and laser ablation fiber. In order to minimize the number of tracts created, we will also develop an optimization algorithm for calculating the “optimal” puncture location and desired trajectory for the CTR. The rationale that underlies the proposed research is that the CTR inserted along a desired trajectory through an optimal port will enable the urologist to safely obtain access to the entire stone through a single tract, thereby ensuring complete stone removal while minimizing damage to the kidney parenchyma. In addition, the navigation system will aid in visualizing and targeting the stones in 3 dimensions, thereby providing enhanced depth perception compared to the standard 2D projection fluoroscopy. We plan to achieve the objective by pursuing the following specific aims: 1) Develop a hand-held CTR device instrumented with a position sensor to cover the entire calyx and deliver the laser fiber. We will also develop an algorithm to evaluate the optimal puncture location to enable access to the entire stone while maximizing the dexterity of the CTR. 2) Develop surgical navigation software that fuses the diagnostic CT and intraoperative tracked ultrasound images to visualize the CTR and neighboring anatomy in real-time. 3) Validate the CTR device and navigation system in ex-vivo kidney tissue and porcine models. The proposed research is significant since it will enable a higher stone-free rate while reducing the complication rate associated with the PCNL procedure. The proposed research is innovative in that it builds on state-of-the-art CTR technology, motion planning and navigation algorithms, and mixed-reality visualization modalities to enable urologists to accurately and safely target kidney calculi during PCNL.