Registered Ultrasound-Endoscope

描述（由申请人提供）：拟议的项目旨在促进柔性腹腔镜超声换能器在微创手术（MIS）中的使用，以降低损伤率。在标准的腹腔镜手术中，外科医生通过腹部的小切口进行手术，同时在远程视频监视器上观察内部解剖结构，这就产生了眼-手-仪空间协调问题。因此，许多伤害发生在MIS过程中。腹腔镜超声提供了更全面的解剖了解，为腹腔镜相机图像提供了补充的解剖信息，从而降低了损伤的风险。然而，它的使用加剧了传统MIS固有的空间协调问题，因为相同的解剖特征在两种成像方式之间表现得非常不同。如果没有丰富的经验，精确放置诸如针头之类的介入性仪器就变得特别困难。这个问题是通过这个项目的引导系统来解决的，它向外科医生显示他的器械是如何根据超声扫描中的特征定位的。第一阶段系统的动态立体图像显示了针的当前位置和方向以及未来的轨迹，并与实时超声图像相结合。针和超声扫描都以实际的空间方向呈现给用户。在第一阶段，开发了一个原型系统并测试了其功效。结果令人震惊：两名专家用户将他们的放置准确率从没有我们指导的60%提高到有我们指导的100%；而两个新手用户（他们以前从未拿过超声波探头）在没有我们指导的情况下，准确度从5%提高到100%。换句话说，如果没有我们的系统，新手用户无法将针放入LUT视频中的功能中，而有了它，他们就不会错过。在这个第二阶段的项目中，我们建议：(1)研究将增加系统有用性的新功能；(2)继续完善原型，以便在项目结束时，它将准备好进行人体临床试验。它将在多个动物研究中进行定量和定性测试。我们还将在临床环境中测试其可用性，并通过实验评估整个II期开发的新功能的有用性。

DESCRIPTION (provided by applicant): The proposed project aims to facilitate the use of flexible laparoscopic ultrasound transducers during minimally invasive surgery (MIS) in order to reduce injury rates. During a standard laparoscopic procedure, the surgeon operates through small incisions in the abdomen while viewing the internal anatomy on a remote video monitor, creating an eye-hand-instrument spatial coordination problem. Because of this, many injuries occur during MIS procedures. Laparoscopic ultrasound provides a more thorough understanding of the anatomy, offering complementary anatomical information to the laparoscopic camera image and thereby decreasing the risk of injury. However, its use aggravates the inherent spatial coordination problem of conventional MIS, since the same anatomical features appear very differently between the two imaging modalities. Precisely placing interventional instruments such as needles becomes particularly difficult without extensive experience.This problem is addressed with the guidance system of this project, which shows the surgeon how his instruments are positioned with respect to features in the ultrasound scan. The dynamic stereoscopic imagery of the Phase I system shows the current position and orientation of the needle as well as its future trajectory, integrated with the live ultrasound image. Both needle and ultrasound scan are presented to the user in their actual spatial orientations. In Phase I, a prototype system was developed and its efficacy tested. The results were stunning: two expert users increased their placement accuracy from 60% without our guidance to 100% with it; while two novice users (who had never before held an ultrasound probe) improved from 5% accuracy without our guidance to 100% with it. In other words, the novice users were not able to place the needle into a feature in the LUT video without our system, and with it they could not miss. In this Phase II project, we propose to (1) investigate new capabilities that will increase the usefulness of the system; and (2) to continue refinement of the prototype so that, at the project's conclusion, it will be ready for clinical trials with human subjects. It will be tested both quantitatively and qualitatively in multiple animal studies. We will also test its usability in a clinical setting, as well as experimentally evaluate the usefulness of the novel features developed throughout Phase II. PUBLIC HEALTH RELEVANCE: We propose to develop an advanced stereoscopic visualization system for minimally-invasive surgery that facilitates the use of laparoscopic ultrasound during MIS interventions, in order to reduce patient injury rates. The system offers three-dimensional guidance for accurate placement of needles or other interventional instruments into structures seen in the laparoscopic ultrasound image, so that the surgeon can conduct the procedure more easily and more safely.