Abstract:Ventricular puncture and drainage is an important first aid method for craniocerebral injury. However, there are some problems such as time-consuming and labour-intensive craniotomy, and difficult to perform without experiencedsurgeons. In order to simplify the first aid process and reduce the requirements of emergency surgery, an image-guided teleoperation ventricular puncture robot system was developed. The system included a teleoperation puncture actuator system, a robotic arm, a preoperative planning system, and a visual navigation system. The pressure sensor differential layout was used to design the skull puncture actuator based on EtherCAT bus. Variability registration based on B-spline transformation was used for surgical planning and visual navigation on CT and MR fused images. Under the guidance of binocular vision, the 7 degree of freedom redundant robotic arm was used to locate the skull puncture actuator to the starting position according to the preoperative planning path and the specified attitude. The operation was visualized by visual tool library (VTK) in human-in-loop operation mode, and the skull puncture was performed under double feedback of visual and force perception. The puncture experiment on the 3D printed skull model showed that the puncture error of the robot was 0.74 mm. Animal experiments on a beagle dog showed that the puncture error was 1.22 mm, which was comparable to the accuracy of experienced emergency physicians, indicating that the robot held the potential for clinical application.
[1] Muralidharan R. External ventricular drains: management and complications[J]. Surgical neurology international, 2015, 6(Suppl 6): S271-S274. [2] Helbok R, Beer R. Cerebrospinal fluid and brain extracellular fluid in severe brain trauma[J]. Handbook of Clinical Neurology, 2018, 146: 237-258. [3] 包钟元,季晶.铁死亡在颅脑外伤中的研究进展[J].南京医科大学学报(自然科学版),2022,42(2):270-278. [4] Dey M, Jaffe J, Stadnik A, et al. External ventricular drainage for intraventricular hemorrhage[J]. Current neurology and neuroscience reports, 2012, 12(1): 24-33. [5] Borkar SA, Singh M, Kale SS, et al. Spinal cerebrospinal fluid drainage for prevention of vasospasm in aneurysmal subarachnoid hemorrhage: A prospective, randomized controlled study[J]. Asian Journal of Neurosurgery, 2018, 13(2): 238-246. [6] Whitelaw A, Lee-Kelland R. Repeated lumbar or ventricular punctures in newborns with intraventricular haemorrhage[J]. Cochrane Database of Systematic Reviews, 2017 (4):1-16. [7] Chau C, Craven C, Rubiano A, et al. The evolution of the role of external ventricular drainage in traumatic brain injury[J]. Journal of Clinical Medicine, 2019, 8(9): 1422-1445. [8] Kwoh YS,Hou J,Jonckheere EA,et al. A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery[J]. IEEE Transactions on Biomedical Engineering,1988,35(2):153-160. [9] Shah J, Vyas A, Vyas D. The history of robotics in surgical specialties[J]. American Journal of Robotic Surgery, 2014, 1(1): 12-20. [10] Eggers G, Wirtz C, Korb W, et al. Robot-assisted craniotomy[J].Minim Invasive Neurosurgery, 2005, 48(3): 154-158. [11] Engelhardt M, Bast P, Jeblink N, et al. Analysis of surgical management of calvarial tumours and first results of a newly designed robotic trepanation system[J]. Min-Minimally Invasive Neurosurgery, 2006, 49(2): 98-103. [12] 郭楚,刘达. 一种手术辅助装置及系统[P].中国专利:110368026B,2021-3-12. [13] 崔萌. 智能人机协同开颅手术机器人系统辅助开颅手术实验验证研究[D].北京:中国人民解放军医学院,2019. [14] Niemeyer GD. Aspects of a control system of a minimally invasive surgical apparatus[P]. USA: 6493608,2002-12-10. [15] Tierney MJ, Cooper TG, Julian CA, et al. Mechanical actuator interface system for robotic surgical tools[P]. USA: 7524320,2002-12-10. [16] Orfanus D, Indergaard R, Prytz G, et al. EtherCAT-based platform for distributed control in high-performance industrial applications[C]//2013 IEEE 18th Conference on Emerging Technologies & Factory Automation (ETFA). Cagliari: IEEE, 2013: 1-8. [17] Delgado R, Hong CH, Shin WC, et al. Implementation and performance analysis of an EtherCAT Master on the latest real-time embedded Linux[J]. International Journal of Applied Engineering Research, 2015, 10(24): 44603-44609. [18] Delgado R, Kim SY, You BJ, et al. An EtherCAT-based real-time motion control system in mobile robot application[C]//2016 13th International Conference on Ubiquitous Robots and Ambient Intelligence (URAI). Xi’an: IEEE, 2016: 710-715. [19] Ozgoren MK. Optimal inverse kinematic solutions for redundant manipulators by using analytical methods to minimize position and velocity measures[J]. Journal of Mechanisms and Robotics, 2013, 5(3): 031009. [20] Luo RC, Ko MC, Chung Y, et al. Repulsive reaction vector generator for whole-arm collision avoidance of 7-DoF redundant robot manipulator[C]//2014 IEEE/ASME International Conference on Advanced Intelligent Mechatronics. Besançon: IEEE, 2014: 1036-1041. [21] Wang Junchen, Lu Chunheng, Zhang Yinghao, et al. A numerically stable algorithm for analytic inverse kinematics of 7-degrees-of-freedom spherical-rotational-spherical manipulators with joint limit avoidance[J]. Journal of Mechanisms and Robotics, 2022, 14(5): 051005. [22] 冈萨雷斯. 数字图像处理 [M]. 北京:电子工业出版社, 2011. [23] Ji Honglei, Lv Yi, Wang Junchen. Fast learning from imperfect labels to segment brain based on active contour model and 3D U-Net[C]//Asian-Pacific Conference on Medical and Biological Engineering. Okayama: Springer, Cham, 2020: 240-248. [24] Mattes D, Haynor DR, Vesselle H, et al. PET-CT image registration in the chest using free-form deformations[J]. IEEE Transactions on Medical Imaging, 2003, 22(1): 120-128. [25] 张英豪,李维全,陈家禾,等.机器人辅助微创全膝关节置换手术系统[J].机器人,2021,43(4):386-394. [26] 王君臣,王田苗,杨艳,等.非线性最优机器人手眼标定[J].西安交通大学学报,2011,45(9):15-20,89. [27] Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview[J]. The Journal of Head Trauma Rehabilitation, 2006, 21(5): 375-378. [28] Liu Baiyun. Current status and development of traumatic brain injury treatments in China[J]. Chinese Journal of Traumatology, 2015, 18(3): 135-136. [29] 徐敏,怀德.正常成人侧脑室高场MRI体积形态测量及角度量化初步研究[J].南京医科大学学报(自然科学版),2013,33(10):1469-1473.