Robotic Mastoidectomy

描述(申请人提供：建议调查使用计算机控制的、自主的机器人来执行特定的外科手术--乳突切除术。乳突切除术是耳鼻咽喉头颈外科中的一项核心手术，之所以被选中，是因为它的频率高(保守估计，美国每年至少进行10万次手术)，涉及的独特解剖结构(重要结构包裹在骨中，在手术干预期间不变形)，手术技术(使用钻头进行，特别适合机器人应用)，以及首席研究员在图像引导耳科手术方面的专业知识。然而，除了耳科手术外，这项拟议的研究还广泛应用于其他包含机器人干预的外科领域。 为了实现机器人乳突切除术的总体目标，我们计划采用如下渐进式方法：(1)乳突切除术中人工操作策略的分析。在给机器人编程以执行人工任务之前，有必要了解人类通常是如何执行该任务的。为此，外科医生在颞骨实验室进行乳突切除术时使用的钻头的运动将通过图像引导的手术系统进行跟踪。通过将记录的动作分解成动作基元来分析记录的动作的时间进程；(2)基于优化的人类动作的机器人乳突切除铣削。来自特定目标1的信息将被用来通过最大限度地减少行程时间和距离来制定优化的铣削策略。优化策略的机器人铣削将与人工铣削进行比较；(3)探索图像引导手术(IGS)实现的新钻孔策略--整体切除组织。由于IGS提供了“X光视觉”，将研究一种独特的策略，即将形状最佳的多面体与乳突体积相匹配，然后进行边缘布线，随后整体切除组织。据推测，这一战略将比具体目标2中审查的人类或机器人干预更有效率。

DESCRIPTION (provided by applicant: It is proposed to investigate the use of a computer-controlled, autonomous, robot to perform a specified surgical procedure-mastoidectomy. Mastoidectomy, a core surgical procedure in Otolaryngology-Head and Neck Surgery, is chosen because of its high frequency (conservative estimate of at least 100,000 procedures performed annually in the United States), the unique anatomy involved (vital structure encased in bone which does not deform during surgical intervention), the surgical technique (performed using a drill and particularly amenable to robotic application), and the principal investigator's expertise in image-guided otologic surgery. In addition to otologic surgery, however, the proposed research has widespread applications to other surgical fields that incorporate robotic intervention. To accomplish the overall goal of a robotic mastoidectomy, a graduated approach is planned as follows: (1) Analysis of human operator strategy in performing mastoidectomies. Before programming a robot to perform a human task, it is necessary to understand how a human typically performs that task. To that end, the motion of a drill used by surgeons to mill away bone as they perform mastoidectomies in the temporal bone laboratory will be tracked via an image-guided surgical system. The time course of the recorded motion will be analyzed via decomposition into action primitives; (2) Robotic mastoidectomy milling based on optimized human motions. The information from Specific Aim 1 will be utilized to develop optimized milling strategies by minimizing time and distance of travel. Robotic milling with optimized strategies will be compared to human milling; (3) Exploration of a new drilling strategy enabled by image-guided surgery (IGS) - en bloc removal of tissue. Because IGS provides "x-ray vision," a unique strategy will be examined, namely, fitting an optimally- shaped polyhedron to the mastoid volume followed by edge routing with subsequent en-bloc removal of the tissue. It is hypothesized that this strategy will be more efficient than either the human or robotic interventions examined in Specific Aim 2.