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Zhang X, Sridhar A, Ha XT, Mehdi SZ, Fortuna A, Magro M, Peloso A, Bicchi A, Ourak M, Aliverti A, Votta E, Vander Poorten E, De Momi E. Path tracking control of a steerable catheter in transcatheter cardiology interventions. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03069-3. [PMID: 38386176 DOI: 10.1007/s11548-024-03069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Intracardiac transcatheter interventions allow for reducing trauma and hospitalization stays as compared to standard surgery. In the treatment of mitral regurgitation, the most widely adopted transcatheter approach consists in deploying a clip on the mitral valve leaflets by means of a catheter that is run through veins from a peripheral access to the left atrium. However, precise manipulation of the catheter from outside the body while copying with the path constraints imposed by the vessels remains challenging. METHODS We proposed a path tracking control framework that provides adequate motion commands to the robotic steerable catheter for autonomous navigation through vascular lumens. The proposed work implements a catheter kinematic model featuring nonholonomic constraints. Relying on the real-time measurements from an electromagnetic sensor and a fiber Bragg grating sensor, a two-level feedback controller was designed to control the catheter. RESULTS The proposed method was tested in a patient-specific vessel phantom. A median position error between the center line of the vessel and the catheter tip trajectory was found to be below 2 mm, with a maximum error below 3 mm. Statistical testing confirmed that the performance of the proposed method exhibited no significant difference in both free space and the contact region. CONCLUSION The preliminary in vitro studies presented in this paper showed promising accuracy in navigating the catheter within the vessel. The proposed approach enables autonomous control of a steerable catheter for transcatheter cardiology interventions without the request of calibrating the intuitive parameters or acquiring a training dataset.
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Affiliation(s)
- Xiu Zhang
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy.
| | - Aditya Sridhar
- Department of Mechanical Engineering, KU Leuven, 3001, Leuven, Belgium
| | - Xuan Thao Ha
- Department of Mechanical Engineering, KU Leuven, 3001, Leuven, Belgium
| | - Syed Zain Mehdi
- Department of Mechanical Engineering, KU Leuven, 3001, Leuven, Belgium
| | - Andrea Fortuna
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Mattia Magro
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Angela Peloso
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Anna Bicchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven, 3001, Leuven, Belgium
| | - Andrea Aliverti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | | | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
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Abstract
Although substantial advancements have been achieved in robot-assisted surgery, the blueprint to existing snake robotics predominantly focuses on the preliminary structural design, control, and human–robot interfaces, with features which have not been particularly explored in the literature. This paper aims to conduct a review of planning and operation concepts of hyper-redundant serpentine robots for surgical use, as well as any future challenges and solutions for better manipulation. Current researchers in the field of the manufacture and navigation of snake robots have faced issues, such as a low dexterity of the end-effectors around delicate organs, state estimation and the lack of depth perception on two-dimensional screens. A wide range of robots have been analysed, such as the i²Snake robot, inspiring the use of force and position feedback, visual servoing and augmented reality (AR). We present the types of actuation methods, robot kinematics, dynamics, sensing, and prospects of AR integration in snake robots, whilst addressing their shortcomings to facilitate the surgeon’s task. For a smoother gait control, validation and optimization algorithms such as deep learning databases are examined to mitigate redundancy in module linkage backlash and accidental self-collision. In essence, we aim to provide an outlook on robot configurations during motion by enhancing their material compositions within anatomical biocompatibility standards.
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Nguyen KT, Kim SJ, Min HK, Hoang MC, Go G, Kang B, Kim J, Choi E, Hong A, Park JO, Kim CS. Guide-Wired Helical Microrobot for Percutaneous Revascularization in Chronic Total Occlusion in-Vivo Validation. IEEE Trans Biomed Eng 2021; 68:2490-2498. [PMID: 33351745 DOI: 10.1109/tbme.2020.3046513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE For the revascularization in small vessels such as coronary arteries, we present a guide-wired helical microrobot mimicking the corkscrew motion for mechanical atherectomy that enables autonomous therapeutics and minimizing the radiation exposure to clinicians. METHODS The microrobot is fabricated with a spherical joint and a guidewire. A previously developed external electromagnetic manipulation system capable of high power and frequency is incorporated and an autonomous guidance motion control including driving and steering is implemented in the prototype. We tested the validity of our approach in animal experiments under clinical settings. For the in vivo test, artificial thrombus was fabricated and placed in a small vessel and atherectomy procedures were conducted. RESULTS The devised approach enables us to navigate the helical robot to the target area and successfully unclog the thrombosis in rat models in vivo. CONCLUSION This technology overcomes several limitations associated with a small vessel environment and promises to advance medical microrobotics for real clinical applications while achieving intact operation and minimizing radiation exposures to clinicians. SIGNIFICANCE Advanced microrobot based on multi-discipline technology could be validated in vivo for the first time and that may foster the microrobot application at clinical sites.
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Bassil G, Markowitz SM, Liu CF, Thomas G, Ip JE, Lerman BB, Cheung JW. Robotics for catheter ablation of cardiac arrhythmias: Current technologies and practical approaches. J Cardiovasc Electrophysiol 2020; 31:739-752. [DOI: 10.1111/jce.14380] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Guillaume Bassil
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Steven M. Markowitz
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Christopher F. Liu
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - George Thomas
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - James E. Ip
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Bruce B. Lerman
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Jim W. Cheung
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
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Abstract
Cardiac mapping has evolved from single point-by-point registration of cardiac electrical activity to its utmost real-time multimodality of mapping and imaging for catheter ablation of arrhythmias. The technology began with electrocardiogram recordings and evolved to the simultaneous registration of depolarization and repolarization using optical mapping and real-time multimodality imaging. Zero to near-zero fluoroscopy is currently used in practice to avoid radiation exposure. Real-time noninvasive mapping, imaging, and ablation of arrhythmias are in use in practice. We present the contemporary up-to-date progress on the role of cardiac mapping and imaging in the diagnosis and management of cardiac arrhythmias.
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Affiliation(s)
- Mohammad Shenasa
- Heart and Rhythm Medical Group, Department of Cardiovascular Services, O'Connor Hospital, 105 North Bascom Avenue, San Jose, CA 95128, USA.
| | - Amin Al-Ahmad
- Saint David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
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Bhimaraj A, Trachtenberg B, Valderrábano M. Robotically Guided Left Ventricular Biopsy to Diagnose Cardiac Sarcoidosis. Circ Heart Fail 2018. [DOI: 10.1161/circheartfailure.117.004627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fetterly K, Schueler B, Grams M, Sturchio G, Bell M, Gulati R. Head and Neck Radiation Dose and Radiation Safety for Interventional Physicians. JACC Cardiovasc Interv 2017; 10:520-528. [DOI: 10.1016/j.jcin.2016.11.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/04/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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Aagaard P, Natale A, Di Biase L. Robotic navigation for catheter ablation: benefits and challenges. Expert Rev Med Devices 2015; 12:457-69. [DOI: 10.1586/17434440.2015.1052406] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Luther V, Jamil-Copley S, Koa-Wing M, Shun-Shin M, Hayat S, Linton NW, Lim PB, Whinnett Z, Wright IJ, Lefroy D, Peters NS, Davies DW, Kanagaratnam P. Non-randomised comparison of acute and long-term outcomes of robotic versus manual ventricular tachycardia ablation in a single centre ischemic cohort. J Interv Card Electrophysiol 2015; 43:175-85. [DOI: 10.1007/s10840-015-9992-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Shurrab M, Schilling R, Gang E, Khan EM, Crystal E. Robotics in invasive cardiac electrophysiology. Expert Rev Med Devices 2014; 11:375-81. [DOI: 10.1586/17434440.2014.916207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Datino T, Arenal A, Pelliza M, Hernández-Hernández J, Atienza F, González-Torrecilla E, Avila P, Bravo L, Fernández-Avilés F. Comparison of the safety and feasibility of arrhythmia ablation using the Amigo Robotic Remote Catheter System versus manual ablation. Am J Cardiol 2014; 113:827-31. [PMID: 24440330 DOI: 10.1016/j.amjcard.2013.11.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 11/16/2022]
Abstract
The aim of this study is to evaluate the safety and feasibility of using the Amigo Remote Catheter System (RCS) in arrhythmia ablation procedures. Because Amigo allows the physician to operate all catheter function outside of the radiation field, operator exposure time was also evaluated. This is a nonrandomized, prospective clinical trial conducted at 1 site (identifier: NCT01834872). The study prospectively enrolled 50 consecutive patients (mean age 59 ± 15 years, 72% men) with any type of arrhythmia (23 atrial fibrillation ablation, 12 common atrial flutters, 10 patients with other supraventricular tachycardia, 4 ventricular tachycardia, and 1 patient with palpitations with no arrhythmia induced) referred for catheter ablation, in which we used RCS. Fifty matched ablation procedures (mean age 57 ± 14 years, 70% men) performed during the same time period, without RCS, were enrolled into the control group. Acute ablation success was 96% with RCS and 98% in the manual group. In only 2 cases, the physician switched to manual ablation (1 ventricular tachycardia and 1 accessory pathway) to complete the procedure. There were no complications related to the use of RCS. No differences were observed in total procedure time, total fluoroscopy time, or total radiofrequency delivery compared with the manual group. In procedures performed with RCS, the operator's fluoroscopy exposure time was reduced by 68 ± 16%. In conclusion, arrhythmia ablation with RCS is safe and feasible. Furthermore, it significantly reduces operator's exposure to radiation.
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Affiliation(s)
- Tomás Datino
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Angel Arenal
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mauricio Pelliza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Pablo Avila
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Loreto Bravo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Baher A, Valderrabano M. Management of ventricular tachycardia in heart failure. Methodist Debakey Cardiovasc J 2013; 9:20-5. [PMID: 23519088 DOI: 10.14797/mdcj-9-1-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Ventricular tachyarrhythmias are common in patients with congestive heart failure. The clinical presentation ranges from an asymptomatic incidental electrocardiographic finding to palpitations, syncope, and sudden cardiac death. Although implantable cardioverter defibrillators successfully prevent sudden cardiac death associated with ventricular fibrillation and ventricular tachycardia, recurrent implantable cardioverter defibrillators shocks remain a clinical management challenge. In this review, we discuss management strategies of ventricular tachycardia in congestive heart failure, including drug therapy, radiofrequency catheter ablation (RFCA), and recent RFCA advances.
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Affiliation(s)
- Alex Baher
- The Methodist Hospital, Houston, Texas, USA
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Remote magnetic navigation for mapping and ablation of right and left ventricular outflow tract arrhythmias. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Parreira L, Cavaco D, Reis-Santos K, Carmo P, Cabrita D, Scanavacca M, Adragão P. Ablação de arritmias da câmara de saída do ventrículo direito e esquerdo com sistema de navegação magnética por controlo remoto. Rev Port Cardiol 2013; 32:489-95. [DOI: 10.1016/j.repc.2012.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 11/23/2012] [Accepted: 12/07/2012] [Indexed: 10/26/2022] Open
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Interventions to decrease the morbidity and mortality associated with implantable cardioverter-defibrillator shocks. Curr Opin Crit Care 2012; 18:432-7. [DOI: 10.1097/mcc.0b013e328357ae68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Nam Kug Kim
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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