Ultrasound Guidance for a Laparoscopic Surgical Robot

描述（由申请人提供）：本提案代表了Intuitive Surgical Systems和约翰霍普金斯大学STTR合作伙伴关系的第二阶段。第一阶段证明了将腹腔镜超声（LUS）功能集成到达芬奇的可行性和前景。第二阶段将为LUS引导的肝脏手术开发一个完整的集成应用环境和试验台手术应用。我们的总体目标是在微创环境中提供“开放式”超声检查的图像质量和访问，同时提高外科医生进行超声引导手术的能力。第II阶段系统将提供对具有LUS功能的daVinci系统用于肝脏手术的潜力的现实评价，以及对设计选择和开发功能的权衡的评价。第二阶段有3个具体目标：具体目标1：开发LUS辅助机器人手术所需的功能能力。我们将扩展第一阶段的体系结构，以提高评估的鲁棒性、灵活性和适用性。其他功能增强包括铰接式机器人LUS探头、原型活检和消融工具、“虚拟夹具”和用于超声成像和病变靶向的改进的半自动化行为、集成到daVinci用户界面中的LUS可视化功能，以及对界面的其他显著增强，允许外科医生与LUS系统、图像和系统的其他功能进行交互。具体目标2：生产用于LUS辅助肝脏手术的集成机器人系统。我们将联合收割机结合这些功能，以生产一种适用于3种肝脏手术的体内测试的系统：1）评估（分期）以定位和测量肿瘤; 2）活检/消融的穿刺针放置; 3）小肿瘤切除。在每种情况下，目标是将目标1中开发的基本功能与足够的特定于应用的工具和软件相结合，以提供必要的临床相关开发环境，并支持目标3中提出的评价。具体目标3：通过体内评价和离体模型评价肝脏手术的整体系统和特定功能的有效性。第二阶段的成功将为一种产品奠定基础，该产品将使外科医生能够以微创方式进行超声引导肝脏手术，并具有目前开放式剖腹手术的图像质量和灵活性。这有可能降低发病率，提高肝癌治疗的疗效和效率。

DESCRIPTION (provided by applicant): This proposal represents the second phase of an STTR partnership involving Intuitive Surgical Systems and Johns Hopkins University. Phase I demonstrated the feasibility and promise of integrating laparoscopic ultrasound (LUS) capability into daVinci. Phase II will develop a complete, integrated application environment and testbed surgical applications for LUS-guided liver surgery. Our general goal is to provide the image quality and access of "open" ultrasonography in a minimally-invasive environment, while also improving the surgeon's ability to do ultrasound-guided procedures. The Phase II system will provide a realistic evaluation of the potential of an LUS-capable daVinci system for hepatic surgery as well as evaluation of the design choices and trade-offs in the functions developed. Phase II has 3 specific aims: Specific Aim 1: Develop functional capabilities required for LUS-assisted robotic surgery. We will extend the Phase I architecture to improve robustness, flexibility, and suitability for evaluation. Other functional enhancements include an articulated robotic LUS probe, prototype biopsy and ablation tools, "virtual fixtures" and improved semi-automated behaviors for ultrasound imaging and targeting of lesions, LUS visualization capabilities integrated into the daVinci user interface, as well as other significant enhancements to the interface permitting the surgeon to interact with LUS system, images, and other functions of the system. Specific Aim 2: Produce an Integrated Robotic System for LUS-Assisted Hepatic Surgery. We will combine these capabilities to produce a system suitable for in-vivo testing of 3 hepatic procedures: 1) assessment (staging) to locate and measure tumors; 2) Needle placement for biopsy/ablation; and 3) resection of small tumors. In each case, the goal is to combine the fundamental capabilities developed in Aim 1 with sufficient application-specific tooling and software to provide necessary clinically relevant context for development and to support the evaluations proposed in Aim 3. Specific Aim 3: Evaluate the effectiveness of the overall system and specific functions for hepatic surgery through in-vivo evaluations and ex vivo phantoms. A successful Phase II will provide the foundation of a product that will enable surgeons to perform US-guided hepatic procedures in a minimally invasive manner with the image quality and dexterity currently available with open laparotomies. This has the potential to reduce morbidity, and improve efficacy and efficiency for liver cancer treatment.