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摘要
醫學影像的出現，為手術帶來了劃時代的變革，微創手術也從原本的高度挑戰性變成日漸普及。然而現今的臨床手術，即使有了CT影像，確認病灶位置後，仍然多憑藉著醫生的經驗動刀。以腦室積水引流穿刺手術為例，缺乏經驗的醫師往往很難一次就下刀至正確位置，造成引流管移位、重複穿刺、感染等情況，手術對病人來說缺乏安全性及穩定性。
過去本研究曾開發出一套機械式巡航系統，利用機械手臂搭配雷射測儀距儀，搭配自行開發之標靶球假體，輔以3D
Slicer三維影像重建軟體、及Matlab
GUI圖形化人機介面進行數學演算、座標疊合與訊息傳遞，為醫師做好整組手術的臨床規劃。然而使用這個方法仍有實務上的改進空間：病人在照CT影像時，需在病人臉上貼上標記點
(Fiducial Marker)，並且在手術前都不能移動標記點的位置，對病人來講是相當困擾的，醫生執行手術也會被標記點阻擋而造成手術不便。
本研究擬開發出一套機械式導引系統，針對水腦症的病患，協助醫師進行腦室積水引流穿刺手術，將3D
Scanner與過去建置之機械式巡航系統結合，搭配影像註冊軟體，以及自行開發之演算法，建立起一套無標記註冊腦室引流穿刺導引手術的流程，解決病人需在臉上貼標記的困擾，同時改良前期的手術規劃流程，使得整個流程更加自動化，提高醫師手術效率及精準度。
關鍵字：CT影像、腦室積水引流穿刺手術、機械式巡航系統、水腦症、3D
Scanner、無標記註冊、自動化
Abstract
The appearance
of the medical image reform the method of surgery, which makes
Minimally-Invasive Surgery become
more and more popular. Though we use CT image to make sure where
the lesions are, Doctors actually perform surgery by their
experience. Take the VP Shunt Surgery
for example, doctors who are lack of experience may cause
some conditions, including mal-position, repeated insertions or
infection, which is not safe and stable enough for the patients.
Last year we
developed a Robotic Surgical Navigation System, using a robot
arm and a laser pointer, combined with the CT images’
information, 3D-printed skull and MATLAB GUI interface, planning
a complete clinical surgery process for the doctor. However,
there still room for improvement for clinical needs, for
example, we should put the Fiducial Marker on the patient’s face
while CT scanning, and can’t take away the marker until the
surgery begin in the process, which is inconvenient for both the
patients and doctors.
This year, we
combine the Robotic Surgical Navigation System developed last
year with 3D Scanner, Register software and some numerical
inputs / outputs and calculations, expect to create a process
for No-marker Registration Robotic Navigation System apply in VP
Shunt Surgery on Hydrocephalus patient. Not only solve the
problem of marker, but also make the system more automatic,
making the surgery more accurate and efficient.
Keywords: CT
image, VP Shunt surgery, Robotic Surgical Navigation System,
Hydrocephalus, No-Marker Registration, automatic
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