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摘要: 目的:为解决目前输尿管软镜(flexible ureteroscopy,FURS)手术过程中存在的操作难度大、稳定性差、手术姿势及协作空间不符人体工程学原理等问题,设计并研发机器人辅助FURS手术系统。方法:设计机器人辅助FURS手术系统,完成工业样机制备,应用3D打印结石肾脏模型及动物实验(猪)验证系统的可行性和使用效果。结果:成功设计“主从”操作模式的机器人辅助FURS手术系统并制备工程样机,实现对FURS各种维度运动的控制,光纤传送系统辅助激光光纤的递送和回撤,3D打印结石肾脏模型及动物实验(猪)客观验证评价了本机器人系统的运动控制效果及操作性能。结论:本研究设计研发的机器人辅助FURS手术系统成功实现对软镜的灵活操控,能够降低传统软镜手术的操作难度、缩短学习曲线、增强操作稳定性、提高术者操作舒适度,从而提高FURS手术的效率与效果。Abstract: Method:Focusing on current clinical needs to design and construct a system of robot-assisted flexible ureteroscopy (RAFURS), which aimed to ease the manipulation process, enhance the stability, improve the ergonomics and shorten the learning curve.Method:We designed a surgery system of RAFURS and constructed the engineering prototype, and it was evaluated by experiments on the 3 D-printed renal stone models and by the animal experiment on porcine, which was used to validate the feasibility and efficacy of RAFURS.Result:The surgery system of RAFURS was designed based on master-slave model and the engineering prototype was produced successfully.All kinds of movements of RAFURS by mechanical control and optical fiber delivery systems assisting in the delivery and withdrawal of laser fibers were achieved.The experiments on the 3 D-printed renal stone models and animal experiments on porcine objectively evaluate the motion control effect and operation performance of RAFURS.Conclusion:The surgery system of RAFURS developed in this study provides a suitable and safe platform for manipulation of flexible ureteroscopy, which eases the manipulation process, enhances the stability and improves the ergonomics compared with classic flexible ureteroscopy.
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Key words:
- urology /
- flexible ureteroscopy /
- robot /
- animal experiment
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[1] Borofsky M S, Shah O.Advances in ureteroscopy[J].Urol Clin North Am, 2013, 40 (1):67-78.
[2] Jeromin L, Sosnowski M.Ureteroscopy in the treatment of ureteral stones:over 10year's experience[J].Eur Urol, 1998, 34 (4):344-349.
[3] Bagley D H, Huffman J L, Lyon E S.Flexible ureterpyeloscopy:diagnosis and treatment in the upper urinary tract[J].J Urol, 1987, 138 (2):280-285.
[4] Knoll T, Jessen J P, Honeck P, et al.Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30mm size[J].World J Urol, 2011, 29 (6):755-759.
[5] Breda A, Ogunyemi O, Leppert J T, et al.Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones[J].Eur Urol, 2009, 55 (5):1190-1196.
[6] Turk C, Petri A, Sarica K, et al.EAU Guidelines on Interventional Treatment for Urolithiasis[J].Eur Urol, 2016, 69 (3):475-482.
[7] Holden T, Pedro R N, Hendlin K, et al.Evidence-based instrumentation for flexible ureteroscopy:a review[J].J Endourol, 2008, 22 (7):1423-1426.
[8] Giusti G, Proietti S, Villa L, et al.Current Standard Technique for Modern Flexible Ureteroscopy:Tips and Tricks[J].Eur Urol, 2016, 70 (1):188-194.
[9] Monga M, Dretler S P, Landman J, et al.Maximizing ureteroscopy deflection:"play it straight"[J].Urology, 2002, 60 (5):902-905.
[10] Ferroud V, Lapouge O, Dousseau A, et al.Flexible ureteroscopy and minipercutaneous nephrolithotomy in the treatment of renal lithiasis less or equal to 2cm[J].Prog Urol, 2011, 21 (2):79-84.
[11] Healy K A, Pak R W, Cleary R C, et al.Hand problems among endourologists[J].J Endourol, 2011, 25 (12):1915-1920.
[12] Elkoushy M A, Andonian S.Prevalence of orthopedic complaints among endourologists and their compliance with radiation safety measures[J].J Endourol, 2011, 25 (10):1609-1613.
[13] Desai M M, Aron M, Gill I S, et al.Flexible robotic retrograde renoscopy:description of novel robotic device and preliminary laboratory experience[J].Urology, 2008, 72 (1):42-46.
[14] Desai M M, Grover R, Aron M, et al.Robotic flexible ureteroscopy for renal calculi:initial clinical experience[J].J Urol, 2011, 186 (2):563-568.
[15] Saglam R, Muslumanoglu A Y, Tokatli Z, et al.A new robot for flexible ureteroscopy:development and early clinical results (IDEAL stage 1-2b)[J].Eur Urol, 2014, 66 (6):1092-1100.
[16] Rassweiler J J, Goezen A S, Jalal A A, et al.A new platform improving the ergonomics of laparoscopic surgery:initial clinical evaluation of the prototype[J].Eur Urol, 2012, 61 (1):226-229.
[17] 中华医学会泌尿外科分会 (中国泌尿系结石联盟).软性输尿管术中国专家共识[J].中华泌尿外科杂志, 2016, 37 (8):561-565.
[18] Charbe N, McCarron P A, Tambuwala M M.Three-dimensional bio-printing:A new frontier in oncology research[J].World J Clin Oncol, 2017, 8 (1):21-36.
[19] Yu X, Liu F, Liang P, et al.Microwave ablation assisted by a computerized tomography-ultrasonography fusion imaging system for liver lesion:an ex vivo experimental study[J].Int J Hyperthermia, 2011, 27 (2):172-179.
[20] Mosbrucker C, Somani A, Dulemba J.Visualization of endometriosis:comparative study of 3-dimensional robotic and 2-dimensional laparoscopic endoscopes[J].J Robot Surg, 2018, 12 (1):59-66.
[21] McCulloch P, Cook J A, Altman D G, et al.IDEAL framework for surgical innovation 1:the idea and development stages[J].BMJ, 2013, 346:f3012.
[22] Ergina P L, Barkun J S, McCulloch P, et al.IDEAL framework for surgical innovation 2:observational studies in the exploration and assessment stages[J].BMJ, 2013, 346:f3011.
[23] Cook J A, McCulloch P, Blazeby J M, et al.IDEAL framework for surgical innovation 3:randomized controlled trials in the assessment stage and evaluations in the long-term study stage[J].BMJ, 2013, 346:f2820.
[24] Hirst A, Agha R A, Rosin D, et al.How can we improve surgical research and innovation?:the IDEAL framework for action[J].Int J Surg, 2013, 11 (10):1038-1042.
[25] Carey R I, Gomez C S, Maurici G, et al.Frequency of Ureteroscope damage seen at a tertiary care center[J].J Urol, 2006, 176 (2):607-610;discussion 610.
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