ROBOTICALLY CONTROLLED INTRALUMENAL INSTRUMENTS FOR FLEXIBLE ENDOSCOPIC INTERVENTION

项目总结/摘要 柔性内窥镜的最新改进已经导致其用于微创手术的爆炸式使用。 诊断和干预。介入肺病学已经看到了显着扩大的程序沿着 随着这些进展，现在可以通过支气管镜进入大、中、甚至远端气道， 法在美国，原发性肺癌占所有癌症死亡的约25%， 方便、有效和完全地筛选已经变得非常重要。 灵活的内窥镜介入的重大技术挑战之一是限制自由度。 内窥镜和通过工作端口的器械之间存在的运动。 手术工具通常与内窥镜远端头端有固定的方向，在大多数情况下，只能推进 沿着内窥镜头端的轴线。此外，使用仪器会降低范围灵活性和可操作性 进一步限制了灵活性。在支气管或气管的狭窄范围内工作限制了 以准确和迅速地将仪器引导到病变或活检目标。因此，手术时间 可能是扩展的，发育不良或恶性病变可以不完全治疗，或周围组织， 不必要的创伤继发于范围定位的挑战。 为了应对柔性内窥镜的持续挑战，我们开发了一种手持式机器人导管 其可以通过柔性支气管镜的器械通道。该导管可容纳 各种各样的仪器，以允许机器人增强的工具关节，从本质上讲， 目前在范围和工具之间存在的严格限制，扩大其范围， 从而允许接近和治疗更远的病变。重要的是，机器人导管可以保持在 并且由一只手操作，使得其使用与现有的手持式柔性内窥镜直接兼容，并且 从而允许单个从业者在没有额外帮助的情况下操作成像器和仪器。 总的来说，项目的目标是（1）开发和验证机器人仪器，（2）进行用户研究， 该装置旨在评价其用于解决可疑患者的中央和外周肺通路的有效性和效率 病理学在这个项目结束时，我们的目标是有一个经过验证的机器人仪器的临床试验。 我们假设技术将继承先前手术机器人系统的观察到的益处，即，减少 手术时间、内窥镜导航造成的邻近组织创伤更少、器械放置更准确，以及 增强提供程序体验。在不更换内窥镜的情况下实现仪器的自动化 将产生一个低成本的解决方案，消除专业设备，人员和设施的负担， 不仅是医院，还有门诊诊所，以提供机器人程序。这有一个重大的 扩大机器人增强诊断和干预的可及性， 全国各地的不同和地理挑战的人口。

PROJECT SUMMARY / ABSTRACT Recent improvements in flexible endoscopes have resulted in an explosion of their use for minimally invasive diagnosis and intervention. Interventional pulmonology has seen a significant expansion of procedures along with these advances, as the large, medium, and even distal airways now can be accessed via bronchoscopic technique. With primary lung cancer accounting for approximately 25% of all cancer deaths in the US, screening expediently, effectively, and completely has become of significant importance. One of the significant technical challenges with flexible endoscopic interventions is the limitation in freedom of movement that exists between the endoscope and the instruments that are passed through the working port. Instruments typically have a fixed orientation to the distal scope tip and, in most cases, only can be advanced along the axis of scope tip. Additionally, scope flexibility and maneuverability reduces with an instrument present, further limiting dexterity. Working within the narrow confines of a bronchus or trachea limits the ability to accurately and expeditiously direct instruments to lesions or biopsy targets. As a result, procedure times may be extended, dysplastic or malignant lesions can be incompletely treated, or surrounding tissues be unnecessarily traumatized secondary to challenges with scope positioning. To address this ongoing challenge with flexible endoscopy, we have developed a handheld robotic catheter that can be passed through the instrument channel of a flexible bronchoscope. The catheter accommodates an assortment of instrumentation to allow for robotically enhanced articulation of tools, in essence, liberating the rigid restrictions of movement that currently exists between scope and instrument, and expanding its reach and allowing for more distal pathology to be accessed and treated. Importantly, the robotic catheter can be held and operated by one hand, making its use directly compatible with existing handheld flexible endoscopes, and allowing a single practitioner to operate both imager and instrumentation without additional help. Overall, the Project Aims are to (1) develop and validate the robotic instrument and (2) perform a user study of the device to evaluate its efficacy and efficiency of central and peripheral lung access for addressing suspect pathologies. At the end of this project, we aim to have a validated robotic instrument for clinical trials. We hypothesize technology will inherit the observed benefits with prior surgical robotic systems, i.e., reduced procedure times, less adjacent tissue trauma from scope navigation, more accurate instrument placement, and enhanced provider procedural experience. Robotizing the instrumentation without changing the endoscope would result in a low-cost solution that removes the burden of specialty equipment, staff, and facilities, allowing not only hospitals but also outpatient clinics to afford and offer robotic procedures. This has a significant potential to expand the accessibility of robotically enhanced diagnostics and intervention to economically diverse and geographically challenged populations across the country.