arXiv 2602.229522026-02-26cs.RO

自动化机器人针刺用于经皮气管切开术

Automated Robotic Needle Puncture for Percutaneous Dilatational Tracheostomy

Manchester Centre for Robotics and AI（曼彻斯特机器人与人工智能中心）；Department of Mechanical and Aerospace Engineering（机械与航空航天工程系）；University of Manchester（曼彻斯特大学）；Department of Electrical and Electronic Engineering（电子与电气工程系）；Manchester University Foundation Trust Wythenshawe Hospital Intensive Care Unit（曼彻斯特大学基金会韦斯豪斯医院重症监护单元）

Yuan Tang, Bruno V. Adorno, Brendan A. McGrath, Andrew Weightman

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AI总结：

本文提出了一种自动化机器人系统，用于提高经皮扩张气管切开术的穿刺精度和安全性。

摘要：

经皮扩张气管切开术（PDT）经常在重症监护病房对需要长期机械通气的患者进行。针刺作为PDT最关键的步骤，如果操作不准确，可能导致严重出血和后壁气管穿孔。目前PDT穿刺都是手动进行，没有导航辅助，导致位置和角度误差较大（5毫米和30度）。为了提高准确性和降低PDT手术难度，我们提出了一种系统，利用速度控制的机器人操作臂自动化针刺。通过两个电磁传感器的姿态数据引导，一个在针尖，另一个在气管内，机器人系统使用自适应约束控制器在线适应不确定的运动学参数，以避免与患者身体和组织在目标附近的碰撞。进行了模拟验证控制器的实现，然后在人偶上进行了四百次PDT穿刺以评估位置和角度的准确性。通过气管内的传感器测量，绝对中位穿刺位置误差为1.7毫米（IQR：1.9毫米），中线偏移为4.13度（IQR：4.55度）。在模拟实验设置中的小偏差以及正式保证的碰撞自由插入表明了机器人PDT穿刺的可行性。

英文摘要：

Percutaneous dilatational tracheostomy (PDT) is frequently performed on patients in intensive care units for prolonged mechanical ventilation. The needle puncture, as the most critical step of PDT, could lead to adverse consequences such as major bleeding and posterior tracheal wall perforation if performed inaccurately. Current practices of PDT puncture are all performed manually with no navigation assistance, which leads to large position and angular errors (5 mm and 30 degree). To improve the accuracy and reduce the difficulty of the PDT procedure, we propose a system that automates the needle insertion using a velocity-controlled robotic manipulator. Guided using pose data from two electromagnetic sensors, one at the needle tip and the other inside the trachea, the robotic system uses an adaptive constrained controller to adapt the uncertain kinematic parameters online and avoid collisions with the patient's body and tissues near the target. Simulations were performed to validate the controller's implementation, and then four hundred PDT punctures were performed on a mannequin to evaluate the position and angular accuracy. The absolute median puncture position error was 1.7 mm (IQR: 1.9 mm) and midline deviation was 4.13 degree (IQR: 4.55 degree), measured by the sensor inside the trachea. The small deviations from the nominal puncture in a simulated experimental setup and formal guarantees of collision-free insertions suggest the feasibility of the robotic PDT puncture.

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