Dexterous Robot-assisted trans-urethral Bladder Resection

描述(申请人提供)：经尿道膀胱肿瘤电切术(TURBT)和病理分期都是非肌肉浸润性膀胱癌的标准外科治疗方法，也是所有膀胱肿瘤诊断评估和进展监测的组成部分。TURBT目前是使用直视显微镜和激光/电灼环进行的。TURBT的结果高度依赖于泌尿外科医生的经验和技术能力以及肿瘤的位置。前部肿瘤要准确切除尤其困难，因为直立的手术工具不能从膀胱点弯曲到膀胱处。外科医生目前依靠公共压力和电切镜倾斜来到达膀胱额侧。然而，由于脂肪层较厚，这项技术在肥胖症患者中的成功有限。此外，不充分的监测和肿瘤分期与误诊肿瘤和高复发率有关。此外，由于工具的限制，肿瘤切除是以零碎的方式进行的。这种方法被认为可能有助于种植新的肿瘤部位，并与使用肿瘤全块切除的标准外科实践相反。外科医生无法证实这一假设，因为缺乏能够进行全块切除的工具。这项探索性生物工程研究奖助金(EBRG)的短期目标集中在开发和评估新型机器人和远程操作算法，以提高膀胱监测和切除的灵活性、准确性和可靠性。本研究的具体目的是：1.设计一种可快速展开的用于经尿道膀胱电切和监护的感官和手术干预远程操控系统；2.将该手术从机集成到一个具有高级远程操控辅助算法的远程操控系统中；3.对该集成系统进行评估。这些特定目标的实现将揭示机器人辅助膀胱切除在提高膀胱切除质量和准确性方面的潜力，以及使用这一新技术实现整体切除的可能性。这种EBRG的长期目标是为患者提供更准确的膀胱切除和监测的替代方案，从而有望减少误诊率，最大限度地减少再次切除的需要，并改善预后。这一长期目标符合国家卫生研究所的使命，因为它侧重于改善患者结局，减少发病率，并为生物医学研究提供新的工具。这项拟议研究的成功完成预计将对提供与普通经腔手术、经胃手术、经子宫手术和经肛门手术相关的外科技术产生更广泛的影响。

DESCRIPTION (provided by applicant): Transurethral resection of bladder tumor (TURBT) and pathological staging are both standard surgical therapies for non-muscle invasive bladder cancer and integral parts of the diagnostic evaluation and progression monitoring of all bladder tumors. TURBT is currently performed using straight resectoscopes and laser/cautery loops. Outcomes of TURBT are highly dependent on the experience and technical ability of the urologic surgeon and the location of the tumor. Anterior tumors are especially tricky to accurately resect due to the inability of straight surgical tools to curve up from the point of enty to the bladder. Surgeons currently rely on public pressure and resectoscope tilt to reach the frontal aspects of the bladder. However this technique has limited success in obese patients due to thick fat layer. Further, inadequate surveillance and tumor staging have been associated with misdiagnosed tumors and with a high recurrence rate. In addition, due to tool limitations, resection of tumors is carried out in a piece-meal fashion. This approach is hypothesized to possibly contribute to seeding new cancer locations and is counter indicative to the standard surgical practice of using en-block resection of tumors. Surgeons cannot validate this hypothesis due to lack of tooling that enables en-block resection. The short term goals of this Exploratory Bioengineering Research Grant (EBRG) focus on developing and evaluating new robots and tele-manipulation algorithms for improving dexterity, accuracy, and reliability of bladder surveillance and resection. The specific aims of this research are: 1. Design a rapidly deployable sensory and surgical intervention telemanipulation slave for transurethral bladder resection and surveillance, 2. Integrate this surgical slave into a telemanipulation system with high level telemanipulation assistive algorithms, 3. Evaluate this integrated system for transurethral bladder resection. Fulfillment of these specific aims will shed light on the potentia of robot-assisted bladder resection for improving quality and accuracy of bladder resection and the possibility of using this new technology to enable en-block resection. The long term goal of this EBRG is to provide patients with the benefits of a more accurate alternative to bladder resection and surveillance that in turn is expected to reduce misdiagnosis rates, minimize need for re-resection, and improve prognosis. This long term goal is in accordance with the mission of the National Health Institute since it focuses on improving patient outcome, reducing morbidity, and providing new tools for biomedical research. Successful completion of this proposed research has an expected broader impact of providing surgical technologies relevant for general trans-luminal surgery, trans-gastric, trans-uterine surgery, and trans-anal surgery.