机器人辅助子宫内膜干细胞精准修复方法研究

Endometrial regeneration using stem cells is a novel therapy treating women’s infertility, but the success rate is strongly limited by current manual operation due to the absent of endometrial injury model and low transplantation accuracy. This project combines the minimally invasive surgical robot and regeneration medicine, and explores methods to improve the operation accuracy and reduce the trauma for this new treatment. Firstly, the endometrial injury area is localized with optical navigation and shape sensing, and combing pre-operative MRI images, 3D endometrial injury model is to be established with human-machine interaction. Secondly, 3D free-hand ultrasound image is introduced to constrain the location of intraoperative 2D ultrasound images, and self-similarity weighted mutual information is used for local non-rigid image registration to register the injury model in surgery. Thirdly, the contact status within confined space is obtained to set boundary constraint for deformation model, and virtual force equation is built to accurately estimate the distal operating force. Finally, hybrid force/position control scheme combing continuum robot’s shape, contact status and estimated force, is used to perform transplant wound creation and stem cell transplantation tasks. This project provides a theoretical exploration on the precise operation in the confined human lumens, and has important clinical application value for improving the validity and safety of endometrial repair using stem cells.

子宫内膜干细胞修复技术是治疗妇女不孕不育的全新术式，但是现有操作缺少子宫内膜损伤模型指导，所用器械也难以满足干细胞移植的精准度需求，严重制约了该项技术的发展。本项目将微创手术机器人与再生医学相结合，探索推动该术式精准微创化发展的基本方法。首先，基于光学导航与形状感知定位子宫内膜损伤区域，结合术前MRI图像，采用人机交互方式建立三维损伤模型；其次，引入术前自由臂三维超声图像约束术中二维超声图像位置，基于互信息结合自相似权重方法完成局部弹性配准，实现损伤模型的术中匹配；第三，获取受限空间内的接触状态，为柔性手术机器人的形变模型施加边界约束，建立虚功方程，准确估计远端操作力；最后，综合形位、接触以及力估计，基于力位混合控制策略实现创面生成与干细胞移植的精准控制。本项目是对狭窄人体腔道内手术机器人精准操作方法的理论性探索，对于提升子宫内膜干细胞修复治疗的有效性和安全性具有重要的临床应用价值。

本项目基于MRI和超声图像进行子宫内膜损伤模型的建立，基于超声进行术前术中图像配准和引导。建立基于离散关节的连续体形变模型，通过被动腱和实时图像处理实现连续体的形状感知，集成FBG光纤传感器对连续体末端与组织的操作力进行精准感知。基于非对称变驱动半径连续体机器人运动学模型完成连续体精准控制，设置宫腔的宫颈口作为远心点，通过支撑臂远心约束控制和连续体执行臂协同控制，降低机器人辅助子宫内膜干细胞修复的风险性，保障患者的安全。本项目的开展解决了子宫内膜损伤模型精准评估和图像引导、适应狭窄宫腔的连续体机器人形状和远端操作力感知，机器人介入宫腔过程精准控制、远心约束控制和协同控制等关键问题，通过动物实验验证机器人辅助子宫内膜干细胞精准修复方法的可行性和精准性，为子宫内膜干细胞修复提供了一种创新的术式和解决方案。