Registered Ultrasound-Endoscope

描述（由申请人提供）：此处申报的项目旨在促进微创手术（MIS）过程中腹腔镜安装超声换能器的使用。在标准腹腔镜手术中，外科医生通过腹部的小切口进行手术，同时在远程视频监视器上查看内部解剖结构;这产生了涉及外科医生的视觉、他的手和腹腔镜器械的显著空间协调问题。因此，许多损伤发生在MIS手术期间。术中超声可以更全面地了解手术区域（从而降低受伤风险），但外科医生必须在第二台监视器上查看额外的视频流。这加剧了传统MIS的空间协调问题;使用腹腔镜超声，外科医生对体内两个不同的组织区域进行成像，并且一个图像中的解剖特征与另一个图像中的相同特征不对应。我们通过注册超声内窥镜（芸香）解决了这个问题。在该系统中，超声视频在空间上与腹腔镜视频配准，并在正确的位置叠加在腹腔镜视频上。以这种方式，组织的回波描记图像将与其在腹腔镜视图中的图像对准。通过将视频图像和超声图像融合到一个统一的显示器中，芸香解决了与腹腔镜超声相关的严重问题（复杂的双显示器界面和困难的空间协调问题）。我们希望该设备通过使其更容易和更快地使用来显著增加腹腔镜超声的使用。在第一阶段的项目中，我们建议开发一个芸香原型，并进行定量和定性测试。建立原型将需要硬件和软件两方面的努力。我们将测试系统的性能准确性，然后与我们的外科医生合作者进行两轮测试。第一轮将使我们能够优化设备的技术和人体工程学方面，而第二轮将定量评估系统的效用。如果获得资助，我们将提出一个第二阶段项目，其中包括在动物模型和人类受试者中进行更大规模的测试。我们最初专注于腹腔镜胆囊切除术，以部署该技术，但我们绝不限于此;该系统可以适用于任何受益于腹腔镜超声的手术。公共卫生相关性：我们提出了一种先进的可视化系统，微创手术（MIS），便于使用腹腔镜超声，有针对性地使用在腹腔镜胆囊切除术，以减少损伤率的胆管。当实现时，所提出的系统将提供甚至超过当前经由腹腔镜或甚至传统的“开放”（即剖腹）方法可获得的视觉信息。它可以适用于不同的程序，并有可能使目前无法通过管理信息系统执行的程序成为管理信息系统的适用程序。与传统的剖腹（或“开放”）方法相比，MIS手术已被证明可以减少创伤、恢复时间、住院时间、住院费用、失血量、术后发热和患者恢复工作的时间。

DESCRIPTION (provided by applicant): The proposed project here aims to facilitate the use of laparoscopically mounted ultrasound transducers during minimally invasive surgical (MIS) procedures. During a standard laparoscopic procedure, the surgeon operates through small incisions in the abdomen while viewing the internal anatomy on a remote video monitor; this creates a significant spatial coordination problem involving the surgeon's vision, his hands and the laparoscopic instruments. Because of this, many injuries occur during MIS procedures. Intra-operative ultrasound could provide a more thorough understanding of the surgery area (and thereby decrease the risk of injury), but the surgeon must then view an additional video stream on a second monitor. This exacerbates the spatial coordination problem of conventional MIS; with laparoscopic ultrasound, the surgeon is imaging two different areas of tissue within the body, and anatomical features in one image do not correspond to the same features in the other. We offer a solution to this problem with the Registered Ultrasound-Endoscope (RUE). In this system, the ultrasound video is spatially registered to the laparoscopic video, and is superimposed over it in the correct location. In this way, the echographic image of the tissue will be aligned to its image in the laparoscope's view. By fusing the video imagery and the ultrasound imagery into a single, unified display, the RUE addresses the serious problems associated with laparoscopic ultrasound (a complex dual-monitor interface and a difficult spatial coordination problem). We expect this device to significantly increase the use of laparoscopic ultrasound, by making it easier and faster to use. In this Phase I project, we propose to develop a RUE prototype and test it both quantitatively and qualitatively. Building the prototype will require both hardware and software efforts. We will test the performance accuracy of the system, followed by two rounds of testing with our surgeon collaborator. The first round will allow us to optimize technological and ergonomic aspects of the device, while the second round will quantitatively assess the system's utility. If funded, we will propose a Phase II project that would include wider-scale testing in animal models and human subjects. We are focusing initially on laparoscopic cholecystectomy for deployment of the technology, but we are by no means limited to it; this system could be adapted to any procedure that would benefit from laparoscopic ultrasound. PUBLIC HEALTH RELEVANCE: We propose an advanced visualization system for minimally-invasive surgery (MIS) that facilitates the use of laparoscopic ultrasound, for targeted use during laparoscopic cholecystectomy in order to reduce the rate of injury to the bile duct. When realized, the proposed system will provide visual information to exceed even that which is currently available via either the laparoscopic or even traditional "open" (i.e. laparotomic) approach. It can be adapted to different procedures, and holds to potential to enable procedures that currently cannot be carried out via MIS to become MIS-amenable. Compared to the conventional laparotomic (or "open") approach, MIS procedures have been shown to reduce trauma, recovery time, length of hospital stay, hospital cost, blood loss, post-operative fever, and time until the patient is able to return to work.