Ross Weston A, Hill Westin M, Hoang Kimberly B, Laarakker Avra S, Mann Brian P, Codd Patrick J
Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina.
Department of Neurosurgery, University of Colorado Denver, Aurora, Colorado.
Lasers Surg Med. 2018 Dec;50(10):1017-1024. doi: 10.1002/lsm.23000. Epub 2018 Jul 9.
Current surgical instruments for soft tissue resection including neurosurgical procedures rely on the accuracy and precision of the human operator and are fundamentally constrained by the human hand. Automated surgical action with the integration of intraoperative data sources can enable highly accurate and fast tissue manipulation using laser ablation. This study presents the first experiments with a prototype designed for automated tumor resection via laser ablation. We demonstrate targeted soft tissue resection in porcine brain with an integrated device that combines 3D scanning capabilities with a steerable surgical laser and discuss implications for future automated robotic neurosurgical procedures.
A device consisting of a two-axis galvanometer for steering a cutting laser and a 3D surface profiler is used to perform volumetric removal of tissue of ex vivo porcine brain. Three-dimensional surface profiles are gathered between cuts and used to estimate ablation rate.
Volumetric ablation of porcine brain tissue is performed and subsequently surface profiled. The average ablation rates across the area cutting areas were 2.6 mm /s and 3.7 mm /s for the initial and subsequent cuts, respectively. A Kruskal-Wallis and post-hoc Tukey test show statistical significance between the initial and subsequent cuts. Accuracy between cuts when benchmarked against a human surgeon varied from 47 to 88%.
A feed-forward volumetric resection is demonstrated with sensing and cutting housed within a single device, thereby opening the potential for automated soft tissue resection as necessary during the surgical removal of pathologic tissues. High variance around target cut depths motivates future work in developing a closed-loop ablation tool as well as characterization of laser-tissue interactions for predictive modelling. Objective Lasers Surg. 50:1017-1024, 2018. © 2018 Wiley Periodicals, Inc.
当前用于软组织切除（包括神经外科手术）的外科手术器械依赖于人类操作员的准确性和精确性，并且从根本上受到人手的限制。将术中数据源集成的自动化手术操作能够使用激光消融实现高度精确和快速的组织操作。本研究展示了首个使用为通过激光消融进行自动化肿瘤切除而设计的原型机所开展的实验。我们展示了在猪脑中使用一种集成设备进行靶向软组织切除，该设备将三维扫描功能与可操纵的手术激光相结合，并讨论了对未来自动化机器人神经外科手术的意义。
使用一种由用于操纵切割激光的双轴振镜和三维表面轮廓仪组成的设备，对离体猪脑的组织进行体积切除。在切割之间收集三维表面轮廓，并用于估计消融速率。
对猪脑组织进行了体积消融，并随后进行了表面轮廓分析。初始切割和后续切割在切割区域的平均消融速率分别为2.6毫米/秒和3.7毫米/秒。Kruskal-Wallis检验和事后Tukey检验显示初始切割和后续切割之间具有统计学意义。与人类外科医生相比，切割之间的准确性在47%至88%之间变化。
展示了一种前馈式体积切除，传感和切割功能集成在单个设备中，从而为在手术切除病理组织时按需进行自动化软组织切除开辟了潜力。目标切割深度周围的高变异性推动了未来开发闭环消融工具以及对激光与组织相互作用进行表征以用于预测建模的工作。《激光手术与医学》50:1017 - 1024, 2018。© 2018威利期刊公司
