Intrasurgical OCT Image-Guided Robot Assist Device for Partial Thickness Corneal Transplanation

项目总结 这是一份探索/发展研究助学金的申请，该助学金汇集了一个 眼科成像、外科和机器人领域的专家将推动图像引导机器人技术的发展 显微外科手术。角膜移植是最常见的同种异体移植手术之一。 在世界范围内，尽管免疫排斥反应或移植物失败的风险仍然很大。另一种形式的 已经描述了被称为深前板层角膜移植(DALK)的角膜移植，它解决了 传统角膜移植的大部分缺点。然而，这一过程需要大量的手工操作 灵巧性和经验，因为深度很难用标准的眼科手术显微镜评估。 即使在有经验的人手中，DALK也经常失败，需要转换到较旧的PKP程序。 在过去的十年里，我们的团队已经成为应用光学技术的领先学术研究小组 相干断层扫描(OCT)技术在眼科显微手术中的应用我们现在的外科显微镜- 集成OCT(MIOCT)系统提供实时、活体的外科领域显微成像，通过 外科医生通过立体平视显示器或立体监视器。在拟议的项目中，我们将 利用这一最先进的成像技术开发一种机器人手术辅助设备，使微尺度 机动性与OCT提供的微尺度可视化效果相匹配。在设想的机器人辅助装置中， 外科医生协作地引导包括机械臂末端执行器的人体工学组织分离器手机 到角膜插入部位，于是新的设备控制软件将产生最佳的针头插入 使用角膜软组织变形模型的轨迹。在外科医生批准该计划后，该设备将 自动执行针的轨迹。任何时候，控制软件都会监控针头的位置 MIOCT可视化(外科医生也可以看到)，补偿外科医生手部震颤，防止穿透 角膜内皮，并允许外科医生修改或终止手术。最终的结果是 该项目将对机器人辅助所需的组件和集成技术进行概念验证 DALK手术，适合在随后的项目中推进到第一个人体试验。 这项提议的预期结果是一套有可能显著增强 克服手术工具可视化和操作的挑战的眼科显微外科技术 千分尺。这些技术将促进外科医生的培训，提高有经验的医生的技能 外科医生，因此有可能改善患者的手术结果。此外，我们认为，发展和 这些技术的展示为转移到其他显微外科应用奠定了基础，例如 神经外科、手外科和其他可能受益于使用OCT的实时显微3D引导的领域 作为潜在的其他成像技术。

PROJECT SUMMARY This is an application for an Exploratory/Developmental Research Grant which brings together a team of experts in ophthalmic imaging, surgery and robotics to advance the state of the art in image-guided robotic microsurgical intervention. Corneal transplants are one of the most commonly performed allograft procedures worldwide, although there remains a substantial risk of immune rejection or graft failure. An alternative form of corneal transplantation known as Deep Anterior Lamellar Keratoplasty (DALK) has been described which solves most of the drawbacks of conventional corneal transplantation. However, this procedure requires great manual dexterity and experience because depth is difficult to assess using the standard ophthalmic surgical microscope. Even in experienced hands, DALK fails more often than not, requiring conversion to the older PKP procedure. Over the past decade, our team has become a leading academic research group applying optical coherence tomography (OCT) technology in ophthalmic microsurgery. Our current surgical microscope- integrated OCT (MIOCT) systems provide real time, in vivo microscopic imaging of the surgical field, viewed by the surgeon via a stereoscopic heads-up display or stereoscopic monitor. In the proposed project, we will leverage this state-of-the-art imaging technology to develop a robotic surgical assist device to enable microscale maneuverability to match the microscale visualization afforded by OCT. In the envisioned robotic assist device, the surgeon cooperatively guides an ergonomic tissue dissector handpiece comprising the robot arm end effector to a corneal insertion site, whereupon novel device control software will generate an optimal needle insertion trajectory using a cornea soft-tissue deformation model. Following surgeon approval of the plan, the device will automatically execute the needle trajectory. At all times, the control software will monitor needle position under MIOCT visualization (also visible to the surgeon), compensate for surgeon hand tremor, prevent penetration of the corneal endothelium, and allow for surgeon modification or termination of the procedure. The end result of this project will be a proof of concept of the component and integrated technologies required for robot-assisted DALK surgery, suitable for advancement to first-in-human trials in a subsequent project. The expected outcome of this proposal is a suite of technologies with the potential to significantly enhance ophthalmic microsurgical technique by overcoming challenges of surgical tool visualization and manipulation on the micrometer scale. These technologies will facilitate surgeon training, advance the skills of experienced surgeons, and thus potentially improve surgical outcomes for patients. Further, we believe that development and demonstration of these technologies forms a foundation for transfer to other microsurgical applications, such as neurosurgery, hand surgery, and others that may benefit from live microscopic 3D guidance using OCT as well as potentially other imaging techniques.