Next Generation Robotic System for Supervised-Autonomous Bowel Anastomosis

项目摘要： 本计画的目标是建立一个新的医疗机器人与手术范例，以执行临床结肠 与共享控制的吻合。我们将开发和评估新型小型化功能3D成像，人工 基于智能（AI）的真实的时间软组织跟踪和故障安全自主控制策略， 在人类自主机器人软组织手术中。这项提案的长期目标是减少 并发症发生率和改善肠道疾病和其他软组织手术的功能结局 独立于外科医生的经验。吻合术是一种关键且具有挑战性的手术， 在美国每年发生百万次。然而，高达19%的胃肠道疾病并发于 渗漏、狭窄和狭窄以及吻合口并发症显著增加患者死亡率，高达10 次最近在外科手术方面取得的关键进展，如越来越多的微创手术（MIS）和机器人， 使用远程操作的达芬奇机器人的辅助手术（RAS）尚未解决影响 吻合结局和总体吻合并发症发生率保持不变。自主机器人 手术系统有潜力显著提高效率，安全性，和一致性超过目前的远程， 操作RAS。自主机器人软组织手术尚未在人类中得到证明，因为缺乏（a） 精确的3D内窥镜视觉，（B）鲁棒的无标记软组织跟踪，以及（c）故障安全自主控制。 为了满足自主机器人手术平台的临床需求，我们开发了一种监督式自主机器人手术平台。 用于引导重建肠吻合的机器人系统。我们建议进行首次人体试验研究 一个自动的机器人平台。因为肠道疾病的并发症 灾难性的，我们实现了逐步逐步增加的复杂性开始与开放overstitching的 闭合普通肠切开术并建立腹腔镜结肠切除术，以确保患者安全。我们 假设自主机器人软组织手术在人类中是可行的，并将执行以下任务： 腹腔镜结肠切除术的准确性和效率优于目前的远程机器人RAS技术。的 以下四个具体目标将使这项技术的发展和证明临床可行性。 我们将开发小型化功能性3D成像和组织健康传感（Aim 1），基于AI的无标记 组织跟踪（目标2），故障安全自主控制策略（目标3），并首次在人体中演示 以常见肠切开术闭合形式进行自主软组织手术（目标4）。肠外 吻合，采用这种方法可能有利于所有软组织MIS和RAS任务，需要 精确性和可操作性，包括复杂的儿科、泌尿外科和心脏外科手术。

Project Summary: The goal of this project is to establish a new medical robot and surgical paradigm to perform clinical colonic anastomosis with shared control. We will develop and evaluate novel miniaturized functional 3D imaging, artificial intelligence (AI) based real time soft tissue tracking, and fail-safe autonomous control strategies that enable first in human autonomous robotic soft tissue surgery. The long-term goal of this proposal is to reduce the complication rates and improve functional outcomes of bowel anastomoses and other soft tissue surgeries independent of surgeon’s experience. Anastomoses are critical and challenging procedures performed over a million times per year in the US. However, up to 19% of gastrointestinal anastomoses are complicated by leakage, strictures, and stenosis, and anastomotic complications significantly increase patient mortality up to ten times. Recent key advances in surgery such as progressively more minimally invasive surgery (MIS) and robot- assisted surgery (RAS) using a tele-operated da Vinci robot have not addressed the critical factors influencing anastomotic outcome, and the overall anastomotic complication rates remain unchanged. Autonomous robotic surgery systems have the potential to significantly improve efficiency, safety, and consistency over current tele- operated RAS. Autonomous robotic soft tissue surgery is yet to be demonstrated in humans due to a lack of (a) accurate 3D endoscopic vision, (b) robust markerless soft tissue tracking, and (c) fail safe autonomous control. To address the clinical need for autonomous robotic suturing platforms, we developed a supervised autonomous robotic system for guiding reconstructive bowel anastomosis. We propose to conduct first-in-human pilot studies of an autonomous robotic suturing platform. Because complications from bowel anastomoses can be catastrophic, we implement a stepwise gradual increase of complexity starting with open overstitching of the closure of a common enterotomy and building up to laparoscopic colectomy to ensure patient safety. We hypothesize that autonomous robotic soft tissue surgery is feasible in humans and will perform the task of laparoscopic colectomy with better accuracy and efficiency over current tele-robotic RAS technology. The following four specific aims will enable the development of this technology and demonstrate clinical feasibility. We will develop miniaturized functional 3D imaging and tissue health sensing (Aim 1), AI based markerless tissue tracking (Aim 2), fail-safe autonomous control strategies (Aim 3), and demonstrate first in human autonomous soft tissue surgery in the form of common enterotomy closures (Aim 4). Beyond intestinal anastomosis, adoption of this approach could be beneficial in all soft tissue MIS and RAS tasks requiring precision and maneuverability, including complex pediatric, urological, and cardiac surgery.