Robot-Assisted Ocular Surgery

1)简要描述研究背景，包括潜在的影响近年来，视网膜下注射在视网膜基因治疗的背景下变得流行起来，用于遗传性视网膜营养不良、年龄相关性退化和其他视网膜疾病。视网膜下注射被认为是最难正确执行的临床操作之一。原因是药物需要准确地输送到视网膜下空间，而视网膜下空间只有几微米深。考虑到目标空间的性质、人手的先天颤动、医疗专业人员的技能水平差异、稳定位置注射的持续时间以及错误交付地点的潜在副作用，机器人手术可以基于目前在剧院使用的成像技术提供系统的稳定和对交付地点和交付体积的精确测量。创建一个精确的机器人注射系统，并将适应人为错误，并极大地提高手术后患者的安全和质量。这项技术的其他应用将包括视网膜血管插管在抢视疾病中的应用，如静脉阻塞。2)目的和目的本项目的目的是构建和测试一个自主的视网膜下注射和插管系统。这将通过将从皇家自由医院收集的患者数据、眼科研究所开发的医学成像和图像处理系统、作为机器人操作基础的人工智能的深度神经网络(DNN)开发和培训以及在伦敦大学学院韦斯实验室构建的机器人模型的构建和重新设计来完成。开发将分为以下目标：a)开发用于精确计算用于VR手术的手术器械和注射药物(气泡)的体积和位置的人工智能算法；B)在人工眼模型上测试UCL Weiss实验室制造的手术机器人的工作原型c)开发用于测试精确输送药物的无生命眼睛模型的工作原型d)动物试验的伦理批准3)研究方法的新颖性研究将整合新测试和开发的技术，并为沿途出现的问题创造新的解决方案。这项研究旨在创建一种基于术中光学相干层析成像(IOCT)的新型手术器械跟踪系统。DNN的开发将自动跟踪以实时聚焦iOCT，补充外科双目增强现实(AR)系统，通过在外科领域顶部可视化iOCT来实现舒适的工作环境。4)与EPSRC的战略和研究领域保持一致该项目与UKRI感兴趣的医疗保健技术领域保持一致。我们的目标是开发一种新的系统，该系统将与现有的手术和成像技术相适应和兼容，而不需要更换现有的系统，而是作为一种补充工具，确保精细手术干预的安全和成功。5)参与该研究的任何公司或合作者都是伦敦大学学院韦斯实验室的一部分。从皇家自由NHS信托基金收集的数据将用于这项研究。Rise团队的目标是申请BMA UK和Roche Holding AG的研究拨款。

1) Brief description of the context of the research including potential impactSubretinal injections have gained popularity in recent years in a context of retinal gene therapy for conditions like inherited retinal dystrophies, age-related degenerations, and other retinopathies. Subretinal injections are deemed one of the most difficult clinical procedures to perform correctly. The reason for that is the drug needs to be delivered exactly to subretinal space which is only a few microns deep. Given the nature of the targeted space, innate tremor of human hands, difference in skill level across the medical professionals, duration of the injection in a stable position, and potential side effect of incorrect delivery site, robotic surgery can offer stabilisation of the system and precise measurement of both the delivery site and delivery volume based on imaging technology currently used in theatres. Creating a precise robotic system for the injections and would accommodate for human error and greatly improve safety and quality of post-operative patients. Additional applications for this technology would include cannulation of retinal vessels in vision robbing diseases such as vein occlusion. 2) Aims and ObjectivesThe aim of this project is to construct and test an autonomous subretinal injection and cannulation system. This would be done by integrating patient data collected from the Royal Free Hospital, medical imaging and image processing systems developed at Institute of Ophthalmology, Deep Neural Network (DNN) development and training for AI which will be a basis for the robot operations, and construction and redesign of the robot model constructed in the UCL WEISS lab.The development would be divided into the following objectives:a) Development of the AI algorithm for precise calculation of volume and position of surgical instruments and injected drugs (blebs) for use in VR surgery; b) Testing the working prototype of the surgical robot made by UCL WEISS lab on artificial eye modelsc) Developing a working prototype for testing on inanimate eye models for precise delivery of drugs calculated by algorithms developed in the previous stepd) Ethical approval for animal testing 3) Novelty of Research MethodologyThe research will integrate newly tested and developed technology and create new solutions for the problems which will arise along the way. The research will aim at creating a novel tracking system for surgical instruments based on intraoperative Optical Coherence Tomography (iOCT). The DNN development will automate tracking for focusing the iOCT in real-time, complement a surgical binocular augmented reality (AR) system for comfortable working environment with visualisation of the iOCT on top of the surgical field. 4) Alignment to EPSRC's strategies and research areasThis project is aligned with UKRI Healthcare Technology area of interest. We aim to develop a novel system that will be adaptable and compatible with already existing surgical and imaging technologies with no need to replace existing systems, but rather as a complimentary tool that will assure safety and success of delicate surgical interventions.5) Any companies or collaborators involvedThe research group ARISE is part of the UCL WEISS lab. Data collected from Royal Free NHS Trust will be used in the study. The ARISE team aims to apply for research grants from both BMA UK and Roche Holding AG.