A Navigational System for Endoscopic Kidney Stone Surgery

项目总结/摘要 强调了在内窥镜肾结石手术中实现无结石状态的重要性， 由于首次手术后残留碎片，重复结石手术的发生率较高。具体来说就是残余结石 碎片可导致阻塞、疼痛、肾损伤和复发性感染。成功内镜取石 手术需要外科医生观察整个肾集合系统 治疗一些挑战可能导致结石治疗不完全，包括结石可见度不足， 难以通过肾脏具体来说，血液或碎片经常会掩盖已经有限的 内窥镜结石手术期间的视野。此外，成功导航通过收集系统 需要外科医生从术前2D轴向在脑海中创建患者解剖结构的3D模型 计算机断层扫描（CT）图像。此外，在治疗过程中， 在整个收集系统中，进一步使术中追踪复杂化。虽然技术限制， 内窥镜也可能影响肾结石手术的结果，上述内窥镜结石治疗的局限性 阻止许多外科医生达到完全无结石的状态。 我们的总体目标是创建一个导航系统，使结石定位和跟踪肾内 收集系统更容易，更准确的外科医生。为了实现这一目标，我们在这方面的具体目标是 该提案旨在验证内窥镜结石手术期间导航系统可以改善结石的假设， 免费率，减少复发手术或残余碎片的并发症。为了验证这个假设，我们 我提出了两个具体目标：目标1涉及自动，实时分割和跟踪的发展 肾结石的治疗方法有哪些Aim 2集成了一个3D导航地图， 系统解剖和肾结石定位。这个R21的终点将是一个完全的 经验证的内窥镜结石手术导航系统和必要的实验数据， 大规模、多中心临床试验。由于我们的导航系统只需要软件集成， 由于现有的内窥镜手术摄像机，所有现有的内窥镜手术系统原则上可以立即 从这个项目的成果中受益。这样，我们相信我们的项目的成功将有助于改善 结石清除率和减少重复干预或并发症，使患者，外科医生和社会受益。

PROJECT SUMMARY/ABSTRACT The importance of achieving stone-free status during endoscopic kidney stone surgery is emphasized by the high rate of repeat stone procedures due to residual fragments after index surgery. Specifically, residual stone fragments can lead to obstruction, pain, kidney injury, and recurrent infections. Successful endoscopic stone surgery requires the surgeon to visualize the entire renal collecting system and locate all kidney stones during treatment. Several challenges can lead to incomplete stone treatment and include inadequate stone visibility and difficulty navigating through the kidney. Specifically, blood or debris can frequently obscure the already limited field of view during endoscopic stone surgery. Additionally, successfully navigating through the collecting system requires the surgeon to mentally create a 3D model of the patient’s anatomy from preoperative 2D axial computerized tomography (CT) images. During treatment, moreover, stones can fragment and disperse throughout the collecting system, further complicating intraoperative tracking. Though technical constraints of scopes may also impact surgical kidney stone outcomes, the above limitations of endoscopic stone treatment prevent many surgeons from achieving a complete stone-free status. Our overall goal is to create a navigational system that makes stone localization and tracking within the renal collecting system easier and more accurate for the surgeon. Toward this goal, our specific objective in this proposal is to test the hypothesis that a navigational system during endoscopic stone surgery can improve stone- free rates, mitigating recurrent surgeries or complications from residual fragments. To test this hypothesis, we propose two Specific Aims: Aim 1 involves the development of an automatic, real-time segmentation and tracking system of kidney stones during endoscopic stone surgery. Aim 2 integrates a 3D navigational map of collecting system anatomy and kidney stone location during endoscopic surgery. The endpoint of this R21 will be a fully validated navigational system for endoscopic stone surgery and the necessary experimental data to power a large-scale, multi-center clinical trial. As our navigational system would require only software integration to current endoscopic surgical cameras, all existing endoscopic surgical systems could in principle immediately benefit from the results of this project. In this way, we believe the success of our project will facilitate improved stone-free rates and mitigate repeat interventions or complications, benefiting patients, surgeons, and society.