用机器人自动切前列腺中叶，97%切除率，适合微创手术自动化研究
A Supervised Autonomous Resection and Retraction Framework for Transurethral Enucleation of the Prostatic Median Lobe
- 分三阶段规划切割路径，结合模型与学习生成手术动作
- 在凝胶仿组织上实现97.1%的靶向组织切除
- 为经尿道机器人手术的监督式自动化提供新框架
同心管机器人（CTRs）可在毫米尺度实现灵活操作，适用于通过自然腔道的微创手术。本文提出一种协同的基于模型的切割规划器与基于学习的回撤网络，共同实现双臂经尿道同心管机器人（Virtuoso）的半自主组织切除。切割规划器直接作用于前列腺假体的分割CT图像，自动生成三阶段中叶切除流程的工具轨迹：左/中沟切割、右/中沟切割、中叶钝性分离。回撤网络PushCVAE通过手术专家示范训练，根据手术阶段生成相应回撤动作。整个过程在由水凝胶材料构成的前列腺假体上以三级（监督）自治水平执行，其机械与切割特性模拟真实组织。作为可行性研究，我们的联合自主系统实现了97.1%的目标中叶组织切除率。本研究为图像引导的经尿道机器人手术自动化奠定了基础，是迈向全自动微创前列腺剜除术的第一步。
原文摘要 · Abstract (English)
Concentric tube robots (CTRs) offer dexterous motion at millimeter scales, enabling minimally invasive procedures through natural orifices. This work presents a coordinated model-based resection planner and learning-based retraction network that work together to enable semi-autonomous tissue resection using a dual-arm transurethral concentric tube robot (the Virtuoso). The resection planner operates directly on segmented CT volumes of prostate phantoms, automatically generating tool trajectories for a three-phase median lobe resection workflow: left/median trough resection, right/median trough resection, and median blunt dissection. The retraction network, PushCVAE, trained on surgeon demonstrations, generates retractions according to the procedural phase. The procedure is executed under Level-3 (supervised) autonomy on a prostate phantom composed of hydrogel materials that replicate the mechanical and cutting properties of tissue. As a feasibility study, we demonstrate that our combined autonomous system achieves a 97.1% resection of the targeted volume of the median lobe. Our study establishes a foundation for image-guided autonomy in transurethral robotic surgery and represents a first step toward fully automated minimally-invasive prostate enucleation.
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