消化内镜微创手术机器人系统的研发及其辅助离体猪胃内镜黏膜下剥离术的可行性评估  

Development and primary evaluation of a minimally invasive surgical robot system in endoscopic submucosal dissection:an ex vivo feasibility study

作　　者：杨笑笑 高沪昕 付士宸 陈剑箫 侯诚 周智峰 季锐[1] 刘会聪 任洪亮 孙立宁[4] 杨嘉林 杨晓云[1] 李延青[1] 左秀丽[1] Yang Xiaoxiao;Gao Huxin;Fu Shichen;Chen Jianxiao;Hou Cheng;Zhou Zhifeng;Ji Rui;Liu Huicong;Ren Hongliang;Sun Lining;Yang Jialin;Yang Xiaoyun;Li Yanqing;Zuo Xiuli(Department of Gastroenterology,Qilu Hospital of Shandong University,Jinan 250000,China;National University of Singapore(Suzhou)Research Institute,Suzhou 215125,China;Robo Medical Technology Co.,Ltd.,Shenzhen 518118,China;School of Mechanical and Electrical Engineering,Soochow University,Suzhou 215137,China;Huaco Healthcare Technologies Co.,Ltd.,Beijing 100086,China;The Chinese University of Hong Kong National University of Singapore,Hong Kong 999077,China)

机构地区：[1]山东大学齐鲁医院消化内科,济南250000 [2]新加坡国立大学苏州研究院,苏州215125 [3]深圳市罗伯医疗科技有限公司,深圳518118 [4]苏州大学机电工程学院,苏州215137 [5]北京华科创智健康科技股份有限公司,北京100086 [6]香港中文大学,中国香港999077 [7]新加坡国立大学

出　　处：《中华消化内镜杂志》2023年第3期182-188,共7页Chinese Journal of Digestive Endoscopy

基　　金：国家重点研发计划(2018YFB1307700)。

摘　　要：目的初步评估新型柔性、双臂、主从操作的消化内镜微创手术机器人——DREAMS(dual-arm robotic endoscopic assistant for minimally invasive surgery)系统辅助内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)的可行性。方法选用新鲜剥离的健康猪胃作为模型,设计不同大小的类圆形病变10个(胃窦和胃体各5个),由2名内镜医生(甲和乙)独自完成内镜下剥离操作,观察DREAMS系统辅助下的剥离效果(黏膜下剥离速度)、安全性(肌层损伤、穿孔发生率)和操作性能(抓取效率:用每个病变需要夹钳夹取的次数来评估)。结果10例机器人辅助下的ESD均顺利完成,10个病变均实现整块切除,病变直径(22.34±2.39)mm,剥离时间(15.00±8.90)min,剥离速度(141.79±79.12)mm2/min,平均每个病变需要夹取4.2次,共有4例(40.0%)ESD出现肌层损伤,无一例穿孔发生。结论初步动物实验结果显示,DREAMS系统辅助ESD安全、可行。Objective To develop a novel,flexible,dual-arm,master-slave digestive endoscopic minimally invasive surgical robot system named dual-arm robotic endoscopic assistant for minimally invasive surgery(DREAMS)and to evaluate its feasibility for endoscopic submucosal dissection(ESD)by using ex vivo porcine stomachs.Methods A novel endoscopic robot(DREAMS)system was developed which was composed of a flexible two-channel endoscope,two flexible robotic manipulators,a master controller,a robotic arm,and a control system.A total of 10 artificial round-like lesions with diameters ranging from 15 to 25 mm were created(5 in gastric antrum and 5 in gastric body)by using fresh peeled stomach of healthy pigs as the model.Submucosal dissection was performed with the assistance of the DREAMS system by two operators.The main outcome was submucosal dissection speed,and the secondary outcomes included muscular injury rate,perforation rate,and grasping efficiency of the robot.Results All 10 lesions were successfully dissected en bloc by using the DREAMS system.The diameter of the artificial lesions was 22.34±2.39 mm,dissection time was 15.00±8.90 min,submucosal dissection speed was 141.79±79.12 mm2/min,and the number of tractions required by each ESD was 4.2 times.Muscular injury occurred in 4/10 cases of ESD.No perforation occurred.Conclusion The initial animal experiment shows the DREAMS system is safe and effective.

关 键 词：胃肠内窥镜 内镜机器人 微创手术机器人 内镜黏膜下剥离术 

分 类 号：R656.61[医药卫生—外科学]