可撓性腹腔鏡安全感測控制方法於機器人微創手術之應用

Abstract

腹腔鏡手術是外科手術中較具挑戰性的，腹腔鏡手術為一種微創手術，除了負責執行開刀動作的醫師之外，腹腔鏡的使用需要仰賴另一位助理醫生以手動的方式調整鏡頭位置，這就要外科醫師和助手之間的培訓和高合作工作操作。因此，開始有人使用機器人輔助微創手術，希望藉由機器人的穩定、易操作、不易抖動等特性來幫助手術進行。 然而，機器人輔助微創手術的安全性問題是需要研究和探討。我們使用機器人多關節可撓性腹腔鏡系統（RFLS），研究主要是針對安全性做探討，分為三大類：接觸、微調、手術安全操作。接觸方面，針對腹腔鏡視野外無法看見的情況，當腹腔鏡末端接觸到手術器械或組織時，系統可以調整移動權重並且顯示紅色警示在螢幕上，避免產生出血等危險情況。微調，由於遠端控制的時間延遲，造成醫師操作上很難去微調，我們提出運動分割功能，可以記錄並重複移動的軌跡，並且藉由分割器將移動軌跡切成許多小線段，可以更細部地操作腹腔鏡。手術安全操作方面，當醫師操作此系統時，視野會隨著頭部操作而移動，醫師在執行手術時無法專注在螢幕上，因此，我們提出自動追蹤功能，可以辨識手術器械位置並移動到使用者偏好的中心點位置。實驗結果顯示安全控在17g/cm^2以上能避免不必要的接觸，醫師能對腹腔鏡進行微調操作且誤差小於0.8度，追蹤系統能在安定時間1.5秒內穩定地到達準確的目標。

Laparoscopic surgery remains a challenging procedure. Laparoscopic surgery is a kind of minimally invasive surgery. In addition to the physician performing the surgery, another assistant is required to manipulate the laparoscope. This requires well trained and collaborative actions between the surgeon and the assistant. Therefore, robot-assisted minimally invasive surgery has been introduced due to their stable, easy to operate, and noise removal characteristics. However, safety issues of robot-assisted minimally invasive surgery have to be studied and discussed. We use a Robotic Flexible Laparoscopic System (RFLS) to explore for three aspects: Contact, Fine Tune, and Safety Operation. First of all, the surgeon cannot see outside the field of view of the laparoscope. When the distal of the laparoscope contacts with surgical instruments or tissue, the system we propose can automatically adjust the weighting and displays a red warning line on the monitor. An-other aspect is that the surgeon has difficulty to perform the fine tune due to the time delay of the remote control. We propose the Motion Split function to record the trajectory of the head motion and split it into small segments so that the surgeon can operate the system delicately. Lastly, the user cannot focus on the monitor because the system is controlled by the surgeon’s head movement. Therefore, we propose an Autonomous Tracking System that identifies surgical instruments and moves the laparoscope to the preferred circle. Experimental results show that the laparoscope automatically avoids unnecessary contact above 17g/cm^2. The surgeon can fine tune the laparoscope and the error is less than 0.1 degrees. Besides, the tracking system can accurately and stably move to the target within 1.5 settling time.