多功能机器人化内窥手术分离器用于内窥肺动脉血栓endarterectomy：临床前研究与评估
Multi-function Robotized Surgical Dissector for Endoscopic Pulmonary Thromboendarterectomy: Preclinical Study and Evaluation
AI总结：
本文提出一种基于同心推拉机器人结构的机器人化内窥手术分离器，用于提升内窥肺动脉血栓endarterectomy手术的灵活性与精度，通过实验验证其物理性能及手术模拟效果。
摘要：
慢性严重肺动脉血栓栓塞患者需通过肺动脉血栓endarterectomy (PTE)手术去除肺动脉内的血栓和内膜。在手术过程中，外科医生需使用镊子和分离器精细剥离阻塞物，但现有工具刚性且直，缺乏远端灵活性以进入细小的肺动脉分支。因此，本文提出一种基于同心推拉机器人（CPPR）结构的新型机器人化分离器，能够进入曲折肺动脉的深部细小分支。与传统刚性分离器相比，本设计具有细长性和双段弯曲灵活性。由于CPPR基分离器具有空心且薄壁结构，其3.5mm直径的细长身体可容纳两个通道用于灌注和尖端工具，以及内窥镜摄像头信号线的空间。为了提供精确的手术操作，建立了基于优化的运动学模型，实现了在开环控制策略下，60mm长度的尖端工具定位精度为2mm。因此，借助内窥镜摄像头，传统PTE可能升级为内窥镜PTE。通过实验评估了机器人化分离器的基本物理性能，包括刚度、运动精度和操作性。在离体猪肺手术模拟中也展示了其灵活性和在PTE中的显著优势。
英文摘要：
Patients suffering chronic severe pulmonary thromboembolism need Pulmonary Thromboendarterectomy (PTE) to remove the thromb and intima located inside pulmonary artery (PA). During the surgery, a surgeon holds tweezers and a dissector to delicately strip the blockage, but available tools for this surgery are rigid and straight, lacking distal dexterity to access into thin branches of PA. Therefore, this work presents a novel robotized dissector based on concentric push/pull robot (CPPR) structure, enabling entering deep thin branch of tortuous PA. Compared with conventional rigid dissectors, our design characterizes slenderness and dual-segment-bending dexterity. Owing to the hollow and thin-walled structure of the CPPR-based dissector as it has a slender body of 3.5mm in diameter, the central lumen accommodates two channels for irrigation and tip tool, and space for endoscopic camera's signal wire. To provide accurate surgical manipulation, optimization-based kinematics model was established, realizing a 2mm accuracy in positioning the tip tool (60mm length) under open-loop control strategy. As such, with the endoscopic camera, traditional PTE is possible to be upgraded as endoscopic PTE. Basic physic performance of the robotized dissector including stiffness, motion accuracy and maneuverability was evaluated through experiments. Surgery simulation on ex vivo porcine lung also demonstrates its dexterity and notable advantages in PTE.
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