1
|
Fialka NM, EL-Andari R, Wang S, Dokollari A, Kent WDT, Fatehi Hassanabad A. The Perceval Sutureless Bioprosthetic Aortic Valve: Evolution of Surgical Valve Technology. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:125-135. [PMID: 38465600 PMCID: PMC11055413 DOI: 10.1177/15569845241231989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym, London, UK) as the only true sutureless valve on the market, the objective of this review is to analyze the current literature on Perceval S. Focusing on valve design and deployment as well as applications of the technology for challenging pathology, clinical outcomes are assessed, including a comparison with transcatheter AVR (TAVR). METHODS PubMed and MEDLINE were searched by 3 authors for studies analyzing SUAVR from inception to May 19, 2023. RESULTS SUAVR facilitates minimally invasive surgery and offers an alternative strategy for patients with small aortic annuli. It also has a time-saving advantage for patients who require complex operations. SUAVR results in excellent long-term morbidity, mortality, durability, and hemodynamic function. In comparison with conventional surgical AVR (SAVR), SUAVR does have a greater risk of postoperative pacemaker implantation; however, increasing user experience and refinements in implantation technique have contributed to reductions in this outcome. SUAVR results in morbidity and mortality that is similar to rapid-deployment AVR. Midterm outcomes are superior to TAVR; however, further robust investigation into all of these comparisons is ultimately necessary. CONCLUSIONS SUAVR bridges the gap in technology between SAVR and TAVR. The application of this exciting technology will undoubtedly grow in the coming years, during which additional investigation is paramount to optimize preoperative planning, valve deployment, and reintervention strategies.
Collapse
Affiliation(s)
- Nicholas M. Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan EL-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shaohua Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aleksander Dokollari
- Section of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| |
Collapse
|
2
|
Tamadon I, Sadati SMH, Mamone V, Ferrari V, Bergeles C, Menciassi A. Semiautonomous Robotic Manipulator for Minimally Invasive Aortic Valve Replacement. IEEE T ROBOT 2023; 39:4500-4519. [PMID: 38249319 PMCID: PMC7615540 DOI: 10.1109/tro.2023.3315966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Aortic valve surgery is the preferred procedure for replacing a damaged valve with an artificial one. The ValveTech robotic platform comprises a flexible articulated manipulator and surgical interface supporting the effective delivery of an artificial valve by teleoperation and endoscopic vision. This article presents our recent work on force-perceptive, safe, semiautonomous navigation of the ValveTech platform prior to valve implantation. First, we present a force observer that transfers forces from the manipulator body and tip to a haptic interface. Second, we demonstrate how hybrid forward/inverse mechanics, together with endoscopic visual servoing, lead to autonomous valve positioning. Benchtop experiments and an artificial phantom quantify the performance of the developed robot controller and navigator. Valves can be autonomously delivered with a 2.0±0.5 mm position error and a minimal misalignment of 3.4±0.9°. The hybrid force/shape observer (FSO) algorithm was able to predict distributed external forces on the articulated manipulator body with an average error of 0.09 N. FSO can also estimate loads on the tip with an average accuracy of 3.3%. The presented system can lead to better patient care, delivery outcome, and surgeon comfort during aortic valve surgery, without requiring sensorization of the robot tip, and therefore obviating miniaturization constraints.
Collapse
Affiliation(s)
- Izadyar Tamadon
- Faculty of Engineering Technology, University of Twente, 7522 NB Enschede, The Netherlands, and also with the BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, Italy
| | - S. M. Hadi Sadati
- Robotics and Vision Department in Medicine Lab, School of Biomedical Engineering & Imaging Sciences, King’s College London, SE17EU London, U.K
| | - Virginia Mamone
- Department of Computer Science and the EndoCAS Center for Computer-Assisted Surgery, University of Pisa, 56124 Pisa, Italy
| | - Vincenzo Ferrari
- Department of Computer Science and the EndoCAS Center for Computer-Assisted Surgery, University of Pisa, 56124 Pisa, Italy
| | - Christos Bergeles
- Robotics and Vision Department in Medicine Lab, School of Biomedical Engineering & Imaging Sciences, King’s College London, SE17EU London, U.K
| | - Arianna Menciassi
- BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, Italy
| |
Collapse
|
3
|
Ishikawa N, Watanabe G, Koakutsu T, Horikawa T, Seguchi R, Tomita S, Ohtsuka T. Robotic Surgery for Triple Valve Insufficiency: A Case Report. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:380-383. [PMID: 37534405 DOI: 10.1177/15569845231185394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
A 63-year-old woman was referred to our institution for surgical treatment of triple valve (aortic, mitral, and tricuspid) insufficiency and underwent a robot-assisted endoscopic procedure. Three intercostal ports were placed in the right lateral chest for robotic instruments and a retrograde cardioplegic cannula, and a 5 cm thoracotomy was made for the procedure, which was a mitral valve repair with neochords and ring annuloplasty, an aortic valve replacement with bioprosthetic valve, and a ring tricuspid annuloplasty. Surgery was successfully achieved without blood transfusion or any complications.
Collapse
Affiliation(s)
- Norihiko Ishikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Go Watanabe
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Toru Koakutsu
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Takafumi Horikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Ryuta Seguchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Shigeyuki Tomita
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Toshiya Ohtsuka
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| |
Collapse
|
4
|
Fujimoto D, Taniguchi K, Miura F, Kobayashi H. Alimentary tract obstruction attributed to use of barbed suture for double tract reconstruction after robot-assisted proximal gastrectomy: a case report. BMC Surg 2021; 21:406. [PMID: 34844585 PMCID: PMC8630912 DOI: 10.1186/s12893-021-01407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Anastomotic stenosis following esophagojejunostomy reconstruction by the overlap method with absorbable barbed sutures occurs only rarely in patients who have undergone laparoscopic surgery. We report anastomotic stenosis by the overlap method that we attributed to the lack of tactile sensation during robot-assisted surgery. Case presentation An 83-year-old man underwent robot-assisted laparoscopic proximal gastrectomy and lymph node dissection at our hospital for treatment of gastric cancer. Double tract reconstruction followed with side-to-side esophagojejunostomy (overlap method) performed with an endoscopic linear stapler. On completion of the anastomosis, the enterotomy was closed under robotic assistance with absorbable barbed suture. Once solid foods were introduced, the patient had difficulty swallowing and felt as though his digestive tract was stopped up. When upper gastrointestinal endoscopy was performed, we found the anastomotic lumen to be coated with food residue. After rinsing off the residue with water, we could see barbed suture protruding into the anastomotic lumen that had become entangled upon itself, which explained how the food residue had accumulated. We cut the entangled suture under endoscopic visualization using a loop cutter. Conclusion This case highlights a stricture caused by insufficiently tensioning barbed suture, which subsequently protruded into the anastomotic lumen and became entangled upon itself. We believe this occurrence was associated with the lack of tactile sensation in robot-assisted surgery.
Collapse
Affiliation(s)
- Daisuke Fujimoto
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan.
| | - Keizo Taniguchi
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan
| |
Collapse
|
5
|
Tamadon I, Mamone V, Huan Y, Condino S, Quaglia C, Ferrari V, Ferrari M, Menciassi A. ValveTech: A Novel Robotic Approach for Minimally Invasive Aortic Valve Replacement. IEEE Trans Biomed Eng 2020; 68:1238-1249. [PMID: 32931426 DOI: 10.1109/tbme.2020.3024184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Aortic valve disease is the most common heart disease in the elderly calling for replacement with an artificial valve. The presented surgical robot aims to provide a highly controllable instrument for efficient delivery of an artificial valve by the help of integrated endoscopic vision. METHODS A robot (called ValveTech), intended for minimally invasive surgery (MIS) and consisting of a flexible cable driven manipulator, a passive arm, and a control unit has been designed and prototyped. The flexible manipulator has several features (e.g., stabilizing flaps, tiny cameras, dexterous introducer and custom cartridge) to help the proper valve placement. It provides 5 degrees of freedom for reaching the operative site via mini-thoracotomy; it adjusts the valve and expands it at the optimal position. The robot was evaluated by ten cardiac surgeons following a real surgical scenario in artificial chest simulator with an aortic mockup. Moreover, after each delivery, the expanded valve was evaluated objectively in comparison with the ideal position. RESULTS The robot performances were evaluated positively by surgeons. The trials resulted in faster delivery and an average misalignment distance of 3.8 mm along the aorta axis; 16.3 degrees rotational angle around aorta axis and 8.8 degrees misalignment of the valve commissure plane to the ideal plane were measured. CONCLUSION The trials successfully proved the proposed system for valve delivery under endoscopic vision. SIGNIFICANCE The ValveTech robot can be an alternative solution for minimally invasive aortic valve surgery and improve the quality of the operation both for surgeons and patients.
Collapse
|
6
|
Kheradvar A, Jafarkhani H, Guy TS, Finn JP. Prospect of artificial intelligence for the assessment of cardiac function and treatment of cardiovascular disease. Future Cardiol 2020; 17:183-187. [PMID: 32933328 DOI: 10.2217/fca-2020-0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, CA 92697, USA
| | - Hamid Jafarkhani
- Center for Pervasive Communications & Computing, University of California, Irvine, Irvine, CA 92697, USA
| | - Thomas Sloane Guy
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - John Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| |
Collapse
|
7
|
Tamadon I, Huan Y, de Groot AG, Menciassi A, Sinibaldi E. Positioning and stiffening of an articulated/continuum manipulator for implant delivery in minimally invasive surgery. Int J Med Robot 2020; 16:e2072. [PMID: 31876096 DOI: 10.1002/rcs.2072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hollow, bendable manipulators can advance implant delivery in minimally invasive surgery, by circumventing the drawbacks of straight-line delivery and fostering single-port approaches. Variable stiffness manipulators are sought to be safe and effective. METHODS We designed and experimentally assessed a cable-driven articulated/continuum manipulator, devised for cardiac valve delivery. Positioning and stiffening were teleoperated, based on cable shortening. Stiffening was parameterized by using the leading tension (LT, ie, tension of the cables driving bending). We assessed positioning (repeatability/reversibility along eight/two bending directions) and stiffening (eight bent configurations). RESULTS We achieved good repeatability and reversibility (mean errors <1% and 1.5%, respectively, of the workspace characteristic length). Stiffening was effective (up to 9-fold increase, depending on pose). Stiffening was linearly correlated (R2 = 0.92) with LT for all the considered configurations. CONCLUSION We accurately positioned and effectively stiffened the manipulator in several bent configurations. The proposed stiffness modulation strategy can be extended to other manipulators.
Collapse
Affiliation(s)
- Izadyar Tamadon
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Yu Huan
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.,Center for Micro-BioRobotics, Istituto Italiano di Tecnologia, Pontedera, Italy
| | | | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Edoardo Sinibaldi
- Center for Micro-BioRobotics, Istituto Italiano di Tecnologia, Pontedera, Italy
| |
Collapse
|
8
|
Balkhy HH, Lewis CT, Kitahara H. Robot-assisted aortic valve surgery: State of the art and challenges for the future. Int J Med Robot 2018; 14:e1913. [DOI: 10.1002/rcs.1913] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/26/2017] [Accepted: 03/07/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Husam H. Balkhy
- Section of Cardiac and Thoracic Surgery; The University of Chicago Medicine; Chicago Illinois USA
| | - Clifton T.P. Lewis
- Department of Cardiothoracic Surgery; Princeton Baptist Medical Center; Birmingham Alabama USA
| | - Hiroto Kitahara
- Section of Cardiac and Thoracic Surgery; The University of Chicago Medicine; Chicago Illinois USA
| |
Collapse
|
9
|
Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice. Surg Endosc 2017; 32:24-38. [PMID: 28812154 DOI: 10.1007/s00464-017-5796-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/28/2017] [Indexed: 12/28/2022]
|