智能开颅手术机器人系统在开颅手术中应用的实验研究

Experimental research on efficacy of intelligent human-machine collaborative robot-assisted cranio-tomy system

目的探讨Cranibot智能开颅手术机器人系统在开颅手术中应用的精确性、效率性及安全性。方法应用解放军总医院第一医学中心神经外科和北京理工大学智能机器人研究所联合研发的Cranibot智能开颅手术机器人系统分别进行3种实验对象的随机分组对照实验研究,包括8个3D打印的PVC颅骨模型、5只家猪离体头颅、5只在体巴马小型猪头颅。每种实验对象对称选择左、右侧各2个部位进行钻孔开颅,每个部位钻孔4个,形成一个方形骨瓣;随机选择头颅一侧的1个部位开颅为实验组,另一侧对称的部位开颅为对照组。实验组由机器人进行开颅,对照组由同一组操作者进行开颅。分别观察和测定两组的钻孔位置误差、开颅用时及组织损伤发生率。结果颅骨模型实验中,实验组的开颅钻孔位置误差和开颅用时分别为(1.87±0.66)mm、(6.64±1.15)min;对照组的相应指标分别为(3.14±0.73)mm、(8.06±1.10)min,差异均有统计学意义(均P<0.05)。家猪离体头颅实验中,实验组的开颅钻孔位置误差和开颅用时分别为(3.13±0.35)mm、(7.79±1.21)min,对照组的相应指标分别为(3.83±0.42)mm、(9.05±1.15)min,差异均有统计学意义(均P<0.05)。在体小型猪头颅实验中,实验组的开颅钻孔位置误差和开颅用时分别为(3.26±0.51)mm、(11.83±0.92)min;对照组的相应指标分别为(4.39±0.75)mm、(26.10±1.62)min,差异均有统计学意义(均P<0.05)。实验组总的组织损伤发生率为5.6%(2/36),对照组总的组织损伤发生率为16.7%(6/36),两组比较差异无统计学意义(P>0.05)。结论Cranibot智能开颅手术机器人系统能够提高开颅手术的精确性和效率性,但在安全性方面的验证需要进一步大样本的研究。

Objective To explore the accuracy,efficiency and safety of robot-assisted craniotomy system named Cranibot.Methods The robot system called Cranibot was developed by Department of Neurosurgery,The First Medical Center of Chinese PLA General Hospital and Institute of Intelligent Robotics,Beijing Institute of Technology and then employed to carry out randomized controlled experiments on 3 kinds of subjects including 83D-printing PVC(polyvinyl chloride)skull models,5 cadaveric pig heads and 5 living Bama miniature pigs.Both left and right sides were symmetrically selected in each subject to perform craniotomy,and on each side 4 holes were drilled to form a square bone flap.One part of the skull on one side was randomly categorized into the experimental group in which craniotomy was performed by robot system,and its symmetrical part of skull on the other side belonged to the control group in which craniotomy was performed by the same neurosurgeon team.We observed and measured the drilling position error,time spent on craniotomy and incidence of tissue injury in the two groups.Results In skull model experiments,the average position error and time spent on craniotomy of"robot"group were 1.87±0.66 mm and 6.64±1.15 min,and those of"surgeon"group were 3.14±0.73 mm and 8.06±1.10 min respectively.The differences were statistically significant(both P<0.05).In experiments on cadaveric pig heads,the average position error and time spent on craniotomy of"robot"group were 3.13±0.35 mm and 7.79±1.21 min,and those of"surgeon"group were 3.83±0.42 mm and 9.05±1.15 min respectively.The differences were statistically significant(both P<0.05).In experiments on living Bama miniature pigs,the average position error and time spent on craniotomy of"robot"group were 3.26±0.51 mm and 11.83±0.92 min,and those of"surgeon"group were 4.39±0.75 mm and 26.10±1.62 min respectively.The differences were statistically significant(both P<0.05).The total incidence of tissue injury was 5.6%(2/36)in"robot"groups and 16.7%(6/36)in"surgeon"groups respectively,which had no statistical difference(P>0.05).Conclusion The robot-assisted craniotomy system named Cranibot could improve the accuracy and efficiency of craniotomy,while its safety requires further research with large sample size.