辅助玻璃体视网膜显微手术机器人系统的研制及应用  

Development of cooperative robot-assistant surgery system for vitreoretinal microsurgery and its feasibility test in an animal model

作　　者：陈亦棋[1] 张超特 洪明胜[3] 苏铃雅 陶继伟[1] 杨洋[4] 肖晶晶[5] 沈丽君[1] 

机构地区：[1]温州医科大学附属眼视光医院眼视光学院浙江省眼科医院,325027 [2]温州医科大学附属第一医院急诊科,325000 [3]浙江医院眼科,310000 [4]北京航空航天大学机械工程及自动化学院,100191 [5]厦门大学航空航天学院,361000

出　　处：《中华实验眼科杂志》2017年第1期38-41,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目（51175013）;浙江省医药卫生科技计划项目（WKJ2010-2-018）;浙江省教育厅科研项目（Y201431237）;温州医科大学眼视光学院重大科研项目（YNZD201003）;第二批浙江省医学创新学科建设计划项目（眼底外科学）

摘　　要：背景机器人手术系统已越来越多地用于多个医学领域，也应用于眼科。研究报告显示机器人辅助的手术有许多优点，包括精确性高，灵活性好，减少术者的生理性手颤抖，提高手术的稳定性，缩短学习曲线等，但中国仍无机器人辅助的眼科手术报道。目的从临床实际出发设计和研制辅助玻璃体视网膜显微手术机器人系统并评估其在玻璃体视网膜手术中的应用能力。方法由温州医学院眼科医院与北京航空航天大学共同研制一套辅助玻璃体视网膜显微手术机器人系统，该系统本体具备2个机械手臂，可以握持眼科常用的手术器械，如玻璃体切割头、导光探头、激光笔和23G眼内镊，进行微创的玻璃体视网膜手术操作。由3名低年资眼科医师通过控制器操控机器人2个机械手臂的运动路径对15只离体猪眼行玻璃体切割手术，以验证该系统执行平坦部玻璃体切割和玻璃体后脱离的可行性。玻璃体切割步骤包括制作3个23G巩膜切口、经切口导入手术器械及用曲安奈德诱导和切除玻璃体后脱离。评估手术持续时间、手术成功率和并发症情况。结果15只离体猪眼的玻璃体切割和玻璃体后脱离手术均顺利完成，术中未发现眼球的明显变形，术后未发生医源性视网膜裂孔和视网膜脱离，手术成功率为100％。15只眼手术平均持续时间为（12．76±3．44）min，每个术者平均手术持续时间分别为（13．67±4．23）、（10．83±2．30）和（13．77±1．91）min。结论辅助玻璃体视网膜显微手术机器人系统具有良好的稳定性和精确性，在一定程度上可以代替人手进行玻璃体视网膜手术操作。Background Robotic systems are increasingly utilized in numerous disciplines including ophthalmology. Several reports showed potential benefits of robotic-assisted surgery, such as increased precision and dexterity ,elimination of tremor, task automation and shortening of learning curve. However, there is still no relative report in China. Objective The present study was to develop a novel robotic-assisted vitreoretinal microsurgery system and assess its overall capacities. Methods A robotic-assisted vitreous and retinal microsurgery system was cooperatively built by Eye Hospital of Wenzhou Medical University and Beijing University of Aeronautics. This platform has two mechanical arms, end-effector of each can grip common instruments such as vitrectomy cutter, illumination probe,laser probe,23-gauge intraocular forceps. The intraocular surgical tasks were performed assisted by surgical robot on 15 fresh in vitro porcine eyes by three interns to test the feasibility of performing pars plana vitrectomy （PPV） and posterior vitreous detachment （PVD）. Vitrectomy steps consisted of preparing three 23-gauge scleral incisions,inserting vitreous cutter towards vitreous and retina via the incisions, and using vitreous cutter to induce and remove a PVD assisted with triamcinolone. The duration and the successful completion of the task with or without complications or involuntary events was assessed. Results PPV and PVD procedures were successfully finished on 15 porcine eyes,and no noted deformation of eyeballs during surgery and no iatrogenic complication such as retinal tear or retinal detachment occurred after operations, with the successful rate 100%. The mean duration of surgery was （12.76±3.44） minutes among the 15 eyeballs and the mean duration for each operator was （13.67±4.23）, （ 10.83 ± 2. 30 ） and （ 13.77± 1.91 ） minutes, respectively. Conclusions Robotic-assisted vitreoretinal microsurgery system is varified to have good stability and accuracy in intraocular surgery, and the robotic s

关 键 词：机器人手术 机器人技术/仪器 计算机辅助手术/方法 玻璃体切割术/方法 可行性研究 猪 

分 类 号：R779.6[医药卫生—眼科]