Automated Markerless Robotic Assisted Orthopaedic Surgery

在英国，每年的全膝关节置换术(TKA)总数已从2003年的13,546例增加到2019年的98,147例，NHS每年估计花费5.85亿GB[1]。在同一时期，全膝关节置换术的翻修次数从630例增加到5932例，其中大多数(60%)归因于对齐不良、种植体磨损/骨折和无菌性松动[2]。机器人辅助手术有可能减少这些并发症，提供更自然的膝关节感觉并提高假体存活率[3]。在英国，机器人辅助的TKA手术(r-TKA)正变得越来越频繁。来自国家联合登记处的证据表明，接受r-TKA的人在手术中失血量减少，住院时间减少，关节功能得到改善[3]。当前一代手术机器人的一个主要局限性是需要红外光学跟踪系统来监控病人、手术器械和机器人在手术室的位置。要做到这一点，必须在每个目标上附加一个标记。然而，如果这些标记物在手术过程中被遮挡，摄像机无法检测到它们，这会导致数据丢失。在患者身上贴上刚性标记也很耗时，而且有创性，增加了感染和骨折等并发症的风险。在英国，全膝关节置换术的平均成本为12,000 GB，然而，手术后并发症，如手术部位感染，使每位患者的成本增加了1,618至2,398 GB[6]。基于标记的导航还需要几个器械托盘，这增加了医院的消毒负担，根据S公司目前的机器人系统，全球每年需要410万GB。我们的财团由Smith&Nephew Ltd.，DCSL Ltd和伦敦帝国理工学院组成正在寻求Innovate-UK的资金，以实施一个雄心勃勃的创新项目，专注于开发无标记和自动注册和跟踪患者的四肢，利用深度学习辅助的结构光技术，为机器人辅助的整形手术量身定做，以在手术中持续捕捉患者的解剖结构。这个新平台将集成到S&N的商业可用机器人平台“Navio”中，该平台之前由I-UK资助，将消除对经皮标记减少安装时间的需求。手术过程中的成本和复杂性。该联盟将利用公共资金将自动无标记跟踪技术从最初的概念验证[7]推进到在外科剧场与患者进行现场手术的实际演示，为期28个月，以加快在3yrs.\[1\][https://www.mirror.co.uk/news/uk-news/knee-replacement-operations-cost-nhs-6009303][0]\[2\]T.Peters-and-K.Cleary，EDS内的市场采用，Image-Guided-Interventions:Technology-and-Applications.Berlin，德国：斯普林格-韦拉格，2008\.\[3\]National-Joint-Registry.http://www.njrcentre.org.uk/njrcentre/default.aspx.\[4\]Wysocki-et-al，Femoral-fracture-through-a-previous-pin-site-after-computer-assisted-total-knee-arthroplasty.The-Journal-of-Arthroplasty，2008，Apr1：23(3)：462-5\.\[5\]卡马拉等人，Pin-site-complications-associated-with-computer-assisted-navigation-in-hip-and arthroplasty.The-Journal-of-Arthroplasty.2017Sep1；32(9)：2842-6\.\[6\]NICE(2008a)Surgical-Site-Infection:the-preventions-and-treatment-of-surgical-site-infection.http://guidance.nice.org.uk/CG74\.\[7\]Rodriguez-&-Liu-Automatic-Markerless-Registration-and-Tracking-of-the-bone-for-Computer-Assisted-Orthopaedic-Surgery-IEEE-Access，第8卷，2月2020,42010--42020\.[0]：https://www.mirror.co.uk/news/uk-news/knee-replacement-operations-cost-nhs-6009303

In the UK, the total number of Total Knee Replacements(TKA's) per year has increased from 13,546 in 2003 to 98,147 in 2019 costing the NHS an estimated £585m per year\[1\]. During the same period the number of TKA revisions increased from 630 to 5,932, the majority of these (\>60%) attributed to malalignment, implant wear/fracture and aseptic loosening\[2\].Robotic-assisted surgery has the potential to reduce these complications providing a more natural-feeling knee and increasing implant survivorship\[3\]. In the UK, robot-assisted TKA surgery(r-TKA) is becoming more frequently used. Evidence from national joint registries has shown that people who have undergone r-TKA suffer lower blood loss during surgery, reduced hospital stay and improved joint function\[3\].A major limitation of the current generation of surgical robots is the need for an infrared optical tracking system to monitor the position of the patient , surgical instruments and robot in theatre. To achieve this, a marker has to be attached to each target. However, if these markers become occluded during surgery, they cannot be detected by the camera, which results in loss of data. Attaching rigid markers to the patient is also time consuming and invasive increasing the risk of complications such as infection and fracture \[4-5\].The average cost of a TKA in the UK is £12,000, however, post-surgical complications, e.g surgical site infection, increases this cost by between £1618 and £2398 per patient\[6\].Marker-based navigation also requires several instrument trays that increases sterilisation burden in hospitals, amounting to £4.1m per year globally based on the current utility of S&N's robotic system.Our consortium, which is comprised of Smith&Nephew Ltd, DCSL Ltd and Imperial College London,is pursuing Innovate-UK funding to carry out an ambitious and innovative project that is focussed on developing markerless and automated registration and tracking of the patient's limbs tailored for robotic-assisted orthopedic procedures using structured light technology assisted by deep learning to continuously capture the patient's anatomy during surgery.This new platform will be integrated within S&N's commercially available robotic platform"NAVIO," which was previously supported by I-UK funding, and will obviate the need for percutaneous markers reducing set-up time, cost and complexity during surgery.The consortium will utilise public funding to advance the automated markerless tracking technology from initial proof of concept\[7\] to practical demonstration in a surgical theater in live surgeries with patients over a 28month period in order expedite market adoption within 3yrs.\[1\][https://www.mirror.co.uk/news/uk-news/knee-replacement-operations-cost-nhs-6009303][0]\[2\]T.Peters-and-K.Cleary,Eds.,Image-Guided-Interventions:Technology-and-Applications.Berlin,Germany:Springer-Verlag,2008\.\[3\]National-Joint-Registry.http://www.njrcentre.org.uk/njrcentre/default.aspx.\[4\]Wysocki-et-al,Femoral-fracture-through-a-previous-pin-site-after-computer-assisted-total-knee-arthroplasty.The-Journal-of-Arthroplasty,2008,Apr1:23(3):462-5\.\[5\]Kamara-et-al.,Pin-site-complications-associated-with-computer-assisted-navigation-in-hip-and arthroplasty.The-Journal-of-Arthroplasty.2017Sep1;32(9):2842-6\.\[6\]NICE(2008a)Surgical-Site-Infection:the-preventions-and-treatment-of-surgical-site-infection.http://guidance.nice.org.uk/CG74\.\[7\]Rodriguez-&-Liu-Automatic-Markerless-Registration-and-Tracking-of-the-bone-for-Computer-Assisted-Orthopaedic-Surgery-IEEE-Access,Vol.8,Feb,2020,42010--42020\.[0]: https://www.mirror.co.uk/news/uk-news/knee-replacement-operations-cost-nhs-6009303