Fluidic soft robot for needle guidance and motion compensation for intratympanic steroid injections

1.世界卫生组织估计，听力损失影响着全球5亿人。通过手术方法将药物递送到内耳提供了药物到耳蜗的最佳递送。然而，它带来了风险，例如由于高度侵入性而进一步降低听力。因此，在大多数情况下，通过从中耳扩散到内耳的药物给药是优选的选择，这是在类固醇的鼓室内注射中完成的，其中通过鼓膜将类固醇冲洗到中耳，但治疗效果不确定。目前，这是由受过训练的耳鼻喉科（ENT）外科医生进行的，因为该手术可能会引起患者疼痛，并在内耳或中耳受损时造成永久性听力损失，眩晕或耳鸣的风险。近年来，通过自然孔口进行诊断和治疗的技术的出现呈指数增长。然而，由于其小尺寸、易碎性和高度不均匀的形状，耳孔的形态对其在该领域的采用提出了重大挑战。为了提供朝向内耳药物递送的第一踏脚石，已经引入了用于针引导和运动补偿的流体软机器人用于鼓室内类固醇注射。该设计由一个摄像头和六个集成的流体致动器组成，该致动器能够在管腔内稳定、平移和旋转给定的针。该系统确实可以提供朝向期望目标的针引导，同时减少针运动。然而，虽然它显示出帮助药物递送到中耳腔中的能力，但当前的设计继承了几个限制，这阻止了它直接靶向递送到耳蜗。2.需要进行进一步的研究，以更好地了解最先进的药物输送机制，开发有效监测输送的方法，并将其与定制的软机器人系统相结合。3.作为该项目的一部分，我将开发新的，现实的和传感器化的幻影，可以提供定量评估今天的手动交付，并确定局部药物输送到内耳的疗效。由于目前最先进的内窥镜系统无法通过鼓膜可视化中耳腔，这对于确定药物输送到内耳的功效至关重要，因此我将研究对耳部解剖结构进行成像的新方法，例如通过使用内窥镜视觉与近红外或窄带成像配对。对手术的理解和衍生的成像方法将被纳入一个软机器人平台，以帮助输送和监测输送的有效性，同时确保患者的安全性和舒适性，并大大降低手术风险。4.这个跨学科的研究轨道结合了生物医学工程，医学成像和图像计算以及软机器人技术的各个方面，这可能为药物输送到内耳的民主化铺平道路。进一步了解当前的临床实践可以帮助开发新的交付协议，并为耳鼻喉科外科医生或其他临床工作人员提供培训，这可能导致更广泛地采用内耳病变的治疗。用于可视化中耳腔以评估药物递送到内耳的新成像能力在用于治疗内耳病理的药物发现和评估中是至关重要的。最后，与软机器人系统的集成可以极大地降低这种药物输送方案的风险和技能，从而有可能实现其他ENT手术。这些都与EPSRC的战略和研究领域相结合，通过创新的技术解决方案改变健康和医疗保健，提高生活质量。韦斯和伦敦大学学院剑桥研究所。

1. The World Health organization estimates that hearing loss affects 500 million people worldwide. Delivery of drugs to the inner ear via the surgical approach offers the optimum delivery of drugs to the cochlea. However, it poses risks, such as further reduction in hearing due to the highly invasiveness. Therefore, in most cases administration of drugs through diffusion to the inner ear from the middle ear is the preferred option, which is done in the intratympanic injection of steroids, where flushing of steroids to the middle ear through the ear drum is done, with uncertainty of the treatment's efficiency. This is currently performed by trained ear, nose, and throat (ENT) surgeons as the procedure could induce pain to the patient and pose the risk of inducing permanent hearing loss, vertigo, or tinnitus, if the inner or middle ear is damaged. In recent years, the emergence of technologies for diagnosis and treatment through natural orifices has been exponentially growing. However, the morphology of the ear orifice presents a major challenge for its adoption in this field due to its small dimension, fragility, and highly non-uniform shape. To provide a first steppingstone towards inner ear drug delivery, a fluidic soft robot for needle guidance and motion compensation has been introduced for intratympanic steroid injections. The design constitutes of a camera and six integrated fluidic actuators that is capable in stabilising, translating and rotating of a given needle within a lumen. This system indeed could provide needle guidance towards desired target while reducing needle motion. However, whilst it shows the capability to aid in drug delivery into the middle ear cavity, the current design inherits several limitations which prevent it from targeted delivery directly to the cochlea. 2. Further research needs to be undertaken to better understand state-of-the-art drug delivery mechanisms, develop means for efficient monitoring of the delivery and integrate this with bespoke soft robotic system. 3. As part of this project, I will develop new, realistic and sensorized phantoms which can provide quantitative assessment of today's manual delivery and determine the efficacy of local drug delivery to the inner ear. As current state-of-the-art endoscope systems are incapable of visualizing the middle ear cavity through the ear drum, which is crucial in determining the efficacy of drug delivery to the inner ear, I will research new means of imaging the ear anatomy, for example by using endoscopic vision paired with near-infrared or narrow-band imaging. The gained understanding of the procedure and the derived imaging methodologies will be incorporated in a soft robotic platform inspired by to aid in delivery and monitoring the efficacy of the delivery whilst ensuring patient safety and comfort and greatly de-risking the procedure. 4. This interdisciplinary research track combines aspects from biomedical engineering, medical imaging and image computing and soft robotics, which could pave the way for democratizing drug delivery to the inner ear. Furthering the understanding of current clinical practices could aid in developing new delivery protocols and provide training for ENT surgeons or other clinical staff which could lead to the more widespread adoption of treatment for inner ear pathologies. Novel imaging capabilities for visualizing the middle ear cavity to assess drug delivery to the inner ear are of paramount importance in drug discovery and assessment for treating inner ear pathologies. Finally, the integration with a soft robotic system could greatly de-risk and de-skill such drug delivery protocols with the potential to enable other ENT procedures. These are all alligned with EPSRC' strategy and research area on transforming health and healthcare, improving quality of life through innovative technological solutions.5. WEISS and UCL EAR institute.