全自動化心導管手術系統之設計與開發

Abstract

心導管手術因術後傷口小、手術時間與恢復時間短等特性，逐漸取代心臟繞道手術，成為治療心肌梗塞的主流方法。然而，心導管手術過程中，醫生和護理人員會長時間暴露在輻射環境中，對身體造成負面影響。為了解決這一問題，本研究開發了一套全自動化心導管手術系統，旨在提升心導管手術的安全性與效率。 這套系統包括醫生端設備、病人端設備及自動送線設備。醫生端設備使醫生能在手術室外使用與臨床手術一致的推拉導絲和旋轉導絲手法進行操作；病人端設備則代替醫生在手術室內執行手術，具有旋轉和推送導絲的功能，並將導絲進入病人體內的阻力值回傳給醫生端設備，實現力回饋；自動送線設備則之功能為自動更換導絲或導管，可達成無人輔助手術過程，減少醫護人員的輻射暴露。 在硬體設計方面，本研究採用了兩顆步進伺服馬達設計出可在單一軸上進行位移和旋轉的單軸機械手臂，並在醫生端設備和病人端設備之間加入控制器，以減少響應誤差。軟體方面，使用C#語言撰寫人機介面，並加入有限狀態機進行程式流程管理。通訊上，使用UART與Modbus RTU通訊協定，使三個設備能相互傳輸控制命令與感測器數值。 最後，本研究開發的全自動化心導管手術系統有效提升了手術的安全性和效率，並且通過多次實驗驗證了其實際手術的可行性。

Percutaneous Coronary Intervention (PCI) is gradually replacing Coronary Artery Bypass Grafting (CABG) as the mainstream method for treating acute myocardial infarction due to its smaller postoperative wounds and reduced surgery and recovery time. However, during the PCI procedure, surgeons and nurses are exposed to radiation for extended periods, which negatively impacts their health. To address this issue, this study developed a fully-automated surgical system aimed at enhancing the safety and efficiency of the procedure. This system is divided into three major components: the surgeon-side, the patient-side, and the automatic wire delivery system. The surgeon-side allows the surgeons to perform operations outside the operating room using push-pull and rotational wire techniques consistent with clinical procedures. The patient-side replaces the doctor in performing the surgery in the operating room. It has the function of rotating and pushing the guidewire and transmitting the resistance value of the guidewire as it enters the patient's body back to the surgeon-side to achieve force feedback. The automatic wire delivery system automatically changes the guidewires and catheters during surgeries, eliminating the need for medical staff to manually change them and thereby reducing their radiation exposure. In terms of hardware design, this study utilized two stepper servo motors to design a single-axis robotic arm capable of both displacement and rotation on a single axis. A controller was added between the surgeon-side and patient-side to minimize response errors. For software, the human-machine interface was programmed using C#, incorporating a finite state machine to manage the program flow. Communication between devices was facilitated using UART and Modbus RTU protocols, enabling the three devices to transmit control commands and sensor values to each other. Ultimately, the fully-automated surgical system developed in this study significantly improved the safety and efficiency of the procedure. Its feasibility in actual surgeries was validated through multiple experiments.