Gruijthuijsen Caspar, Colchester Richard, Devreker Alain, Javaux Allan, Maneas Efthymios, Noimark Sacha, Xia Wenfeng, Stoyanov Danail, Reynaerts Dominiek, Deprest Jan, Ourselin Sebastien, Desjardins Adrien, Vercauteren Tom, Vander Poorten Emmanuel
Department of Mechanical Engineering, KU Leuven, Belgium.
Department of Medical Physics & Biomedical Engineering, University College London, UK.
J Med Robot Res. 2018 Apr 20;3. doi: 10.1142/S2424905X18410015.
By intervening during the early stage of gestation, fetal surgeons aim to correct or minimize the effects of congenital disorders. As compared to postnatal treatment of these disorders, such early interventions can often actually save the life of the fetus and also improve the quality of life of the newborn. However, fetal surgery is considered one of the most challenging disciplines within Minimally Invasive Surgery (MIS), owing to factors such as the fragility of the anatomic features, poor visibility, limited manoeuvrability, and extreme requirements in terms of instrument handling with precise positioning. This work is centered on a fetal laser surgery procedure treating placental disorders. It proposes the use of haptic guidance to enhance the overall safety of this procedure and to simplify instrument handling. A method is described that provides effective guidance by installing a forbidden region virtual fixture over the placenta, thereby safeguarding adequate clearance between the instrument tip and the placenta. With a novel application of all-optical ultrasound distance sensing in which transmission and reception are performed with fibre optics, this method can be used with a sole reliance on intraoperatively acquired data. The added value of the guidance approach, in terms of safety and performance, is demonstrated in a series of experiments with a robotic platform.
通过在妊娠早期进行干预，胎儿外科医生旨在纠正先天性疾病或尽量减少其影响。与这些疾病的产后治疗相比，这种早期干预通常实际上可以挽救胎儿的生命，并提高新生儿的生活质量。然而，由于解剖特征脆弱、视野不佳、可操作性有限以及对精确放置器械操作的极高要求等因素，胎儿手术被认为是微创手术（MIS）中最具挑战性的学科之一。这项工作围绕一种治疗胎盘疾病的胎儿激光手术展开。它提出使用触觉引导来提高该手术的整体安全性并简化器械操作。描述了一种方法，通过在胎盘上安装禁区虚拟夹具来提供有效引导，从而确保器械尖端与胎盘之间有足够的间隙。通过全光学超声距离传感的新颖应用，其中发射和接收都通过光纤进行，这种方法可以仅依靠术中获取的数据使用。在一系列使用机器人平台的实验中证明了这种引导方法在安全性和性能方面的附加价值。
