用触觉反馈引导手术,帮医生更准切掉乳腺肿瘤边界。
Touching the tumor boundary: A pilot study on ultrasound based virtual fixtures for breast-conserving surgery
- 通过超声与电磁导航定位肿瘤,触觉反馈提示边界禁区。
- 有触觉辅助时,切除边缘更准确,医生心理负担减轻。
- 适合外科机器人辅助训练与精准肿瘤切除研究者。
目的:乳腺保乳手术中,因肿瘤移动性强、不可触及且边界不规则,界定肿瘤边界极具挑战。为应对此问题,我们提出一种协作式机器人引导系统,通过触觉反馈实现肿瘤定位。本试点研究旨在评估该系统能否成功融入乳腺癌诊疗流程。方法:将小型力反馈机器人改装为带电刀的协同操作工具,结合超声与电磁导航识别肿瘤边界,并在器械触碰边界时施加禁止区域虚拟约束。我们在乳腺模拟物上进行实验,对比有无触觉引导下完成肿瘤切除的效果,从定性与定量两方面评估结果。结果:虚拟约束引导显著改善切除边缘质量;使用者在有触觉反馈时,主观感受任务更轻松、更少焦虑与疲劳。同时发现若干未预料到的手术流程影响,可指导后续设计优化与培训方案调整。结论:结果表明虚拟约束能有效辅助模拟保乳手术中肿瘤边界的定位。未来工作将开展大规模用户研究以进一步验证并完善该引导系统。
原文摘要 · Abstract (English)
Purpose: Delineating tumor boundaries during breast-conserving surgery is challenging as tumors are often highly mobile, non-palpable, and have irregularly shaped borders. To address these challenges, we introduce a cooperative robotic guidance system that applies haptic feedback for tumor localization. In this pilot study, we aim to assess if and how this system can be successfully integrated into breast cancer care. Methods: A small haptic robot is retrofitted with an electrocautery blade to operate as a cooperatively controlled surgical tool. Ultrasound and electromagnetic navigation are used to identify the tumor boundaries and position. A forbidden region virtual fixture is imposed when the surgical tool collides with the tumor boundary. We conducted a study where users were asked to resect tumors from breast simulants both with and without the haptic guidance. We then assess the results of these simulated resections both qualitatively and quantitatively. Results: Virtual fixture guidance is shown to improve resection margins. On average, users find the task to be less mentally demanding, frustrating, and effort intensive when haptic feedback is available. We also discovered some unanticipated impacts on surgical workflow that will guide design adjustments and training protocol moving forward. Conclusion: Our results suggest that virtual fixtures can help localize tumor boundaries in simulated breast-conserving surgery. Future work will include an extensive user study to further validate these results and fine-tune our guidance system.
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