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Motion prediction for beating heart surgery with GRU. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ravigopal SR, Nayar NU, Desai JP. Towards Real-time pose estimation of the Mitral Valve Robot under C-arm X-ray Fluoroscopy. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2021; 3:928-935. [PMID: 35756715 PMCID: PMC9232099 DOI: 10.1109/tmrb.2021.3122351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mitral regurgitation (MR) is a condition caused by a deformity in the mitral valve leading to the backflow of blood into the left atrium. MR can be treated through a minimally invasive procedure and our lab is currently developing a robot that could potentially be used to treat MR. The robot would carry a clip that latches onto the valve's leaflets and closes them to minimize leakage. The robot's accurate localization is needed to navigate the clip to the leaflets successfully. This paper discusses algorithms used to track the clip's position and orientation under real-time using C-arm fluoroscopy. The positions are found through a deep learning semantic segmentation framework and the pose is found by calculating its bending and rotational angles. The robot's bending angle and the clip's rotational angle is found through an equivalent ellipse algorithm and an SVM classifier, respectively, and were validated by comparing orientations obtained from an electromagnetic tracker. The bending angle calculation has an average error of 7.7° and the rotational angle calculation is 76% for classifying them into five classes. Execution times are within 100ms and hence this could be a promising approach in real-time pose estimation.
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Affiliation(s)
- Sharan R Ravigopal
- Medical Robotics and Automation (RoboMed) Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Namrata U Nayar
- Medical Robotics and Automation (RoboMed) Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Jaydev P Desai
- Medical Robotics and Automation (RoboMed) Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
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Liou JC, Peng CW, Chen ZX. Investigation of Cylindrical Piezoelectric and Specific Multi-Channel Circular MEMS-Transducer Array Resonator of Ultrasonic Ablation. MICROMACHINES 2021; 12:mi12040371. [PMID: 33808313 PMCID: PMC8066577 DOI: 10.3390/mi12040371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/17/2021] [Accepted: 03/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND A cylindrical piezoelectric element and a specific multi-channel circular microelectromechanical systems (MEMS)-transducer array of ultrasonic system were used for ultrasonic energy generation and ablation. A relatively long time is required for the heat to be conducted to the target position. Ultrasound thermal therapy has great potential for treating deep hyperplastic tissues and tumors, such as breast cancer and liver tumors. METHODS Ultrasound ablation technology produces thermal energy by heating the surface of a target, and the heat gradually penetrates to the target's interior. Beamforming was performed to observe energy distribution. A resonance method was used to generate ablation energy for verification. Energy was generated according to the coordinates of geometric graph positions to reach the ablation temperature. RESULTS The mean resonance frequency of Channels 1-8 was 2.5 MHz, and the cylindrical piezoelectric ultrasonic element of Channel A was 4.2546 Ω at 5.7946 MHz. High-intensity ultrasound has gradually been applied in clinical treatment. Widely adopted, ultrasonic hyperthermia involves the use of high-intensity ultrasound to heat tissues at 42-45 °C for 30-60 min. CONCLUSION In the ultrasonic energy method, when the target position reaches a temperature that significantly reduces the cell viability (46.9 °C), protein surface modification occurs on the surface of the target.
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Aviles-Rivero AI, Alsaleh SM, Casals A. Sliding to predict: vision-based beating heart motion estimation by modeling temporal interactions. Int J Comput Assist Radiol Surg 2018; 13:353-361. [PMID: 29350321 DOI: 10.1007/s11548-018-1702-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Technical advancements have been part of modern medical solutions as they promote better surgical alternatives that serve to the benefit of patients. Particularly with cardiovascular surgeries, robotic surgical systems enable surgeons to perform delicate procedures on a beating heart, avoiding the complications of cardiac arrest. This advantage comes with the price of having to deal with a dynamic target which presents technical challenges for the surgical system. In this work, we propose a solution for cardiac motion estimation. METHODS Our estimation approach uses a variational framework that guarantees preservation of the complex anatomy of the heart. An advantage of our approach is that it takes into account different disturbances, such as specular reflections and occlusion events. This is achieved by performing a preprocessing step that eliminates the specular highlights and a predicting step, based on a conditional restricted Boltzmann machine, that recovers missing information caused by partial occlusions. RESULTS We carried out exhaustive experimentations on two datasets, one from a phantom and the other from an in vivo procedure. The results show that our visual approach reaches an average minima in the order of magnitude of [Formula: see text] while preserving the heart's anatomical structure and providing stable values for the Jacobian determinant ranging from 0.917 to 1.015. We also show that our specular elimination approach reaches an accuracy of 99% compared to a ground truth. In terms of prediction, our approach compared favorably against two well-known predictors, NARX and EKF, giving the lowest average RMSE of 0.071. CONCLUSION Our approach avoids the risks of using mechanical stabilizers and can also be effective for acquiring the motion of organs other than the heart, such as the lung or other deformable objects.
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Affiliation(s)
- Angelica I Aviles-Rivero
- Department of Pure Mathematics & Mathematical Statistics, University of Cambridge, Cambridge, UK.
| | - Samar M Alsaleh
- Department of Computer Science, The Institute for Biomedical Engineering, George Washington University, Washington, DC, USA
| | - Alicia Casals
- The Research Center of Biomedical Engineering (CREB), Universitat Politècnica de Cataluya, Barcelona, Spain
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Chen Y, Godage IS, Tse ZTH, Webster RJ, Barth EJ. Characterization and Control of a Pneumatic Motor for MR-conditional Robotic Applications. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2017; 22:2780-2789. [PMID: 31105420 PMCID: PMC6519483 DOI: 10.1109/tmech.2017.2767906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Magnetic Resonance (MR) guided interventional robots have recently been developed for a variety of surgeries, such as biopsy, ablation, and brachytherapy. The actuators and encoders that power and track such robots must be MR-conditional. In this paper, we propose an MR-conditional pneumatic motor with an integrated and custom-built fiber-optical encoder that provides powerful and accurate actuation. The motor is coupled with a modular plastic gearbox that provides a variety of gear ratio options so that the motor can be adapted to application requirements. With a 100:1 gear reduction at 0.55 MPa, the motor achieves 460 mNm stall torque and 370 rpm no-load speed, which leads to the peak output power of 6W. The motor has the bandwidth of approximately 1.1 Hz and 3.5 Hz when connected to 8 m and 0.2 m air hoses, respectively. The motor was tested in a 3T MRI scanner. No image artifact was observed and maximum signal to noise ratio (SNR) variation was less than 5%. Different from most of the existing MR-conditional pneumatic actuators, the proposed motor shape is more like the traditional electric motors, which offers more flexibility in the MR-conditional robot design.
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Affiliation(s)
- Yue Chen
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37212, USA
| | - Isuru S Godage
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37212, USA
| | - Zion Tsz Ho Tse
- College of Engineering, The University of Georgia, Athens, GA, 30605, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37212, USA
| | - Eric J Barth
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37212, USA
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Vrooijink GJ, Denasi A, Grandjean JG, Misra S. Model predictive control of a robotically actuated delivery sheath for beating heart compensation. Int J Rob Res 2017; 36:193-209. [PMID: 30814767 PMCID: PMC6368306 DOI: 10.1177/0278364917691113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Minimally invasive surgery (MIS) during cardiovascular interventions reduces trauma and enables the treatment of high-risk patients who were initially denied surgery. However, restricted access, reduced visibility and control of the instrument at the treatment locations limits the performance and capabilities of such interventions during MIS. Therefore, the demand for technology such as steerable sheaths or catheters that assist the clinician during the procedure is increasing. In this study, we present and evaluate a robotically actuated delivery sheath (RADS) capable of autonomously and accurately compensating for beating heart motions by using a model-predictive control (MPC) strategy. We develop kinematic models and present online ultrasound segmentation of the RADS that are integrated with the MPC strategy. As a case study, we use pre-operative ultrasound images from a patient to extract motion profiles of the aortic heart valve (AHV). This allows the MPC strategy to anticipate for AHV motions. Further, mechanical hysteresis in the steering mechanism is compensated for in order to improve tip positioning accuracy. The novel integrated system is capable of controlling the articulating tip of the RADS to assist the clinician during cardiovascular surgery. Experiments demonstrate that the RADS follows the AHV motion with a mean positioning error of 1.68 mm. The presented modelling, imaging and control framework could be adapted and applied to a range of continuum-style robots and catheters for various cardiovascular interventions.
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Affiliation(s)
- Gustaaf J Vrooijink
- Department of Biomechanical Engineering, University of Twente, The Netherlands
| | - Alper Denasi
- Department of Biomechanical Engineering, University of Twente, The Netherlands
| | - Jan G Grandjean
- Department of Biomechanical Engineering, University of Twente, The Netherlands.,Department of Cardiothoracic Surgery, Thorax Centre Twente, The Netherlands
| | - Sarthak Misra
- Department of Biomechanical Engineering, University of Twente, The Netherlands.,Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, The Netherlands
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Mohamadipanah H, Parthiban C, Nathwani J, Rutherford D, DiMarco S, Pugh C. Can a virtual reality assessment of fine motor skill predict successful central line insertion? Am J Surg 2016; 212:573-578.e1. [DOI: 10.1016/j.amjsurg.2016.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 11/27/2022]
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Florez JM, Shah M, Moraud EM, Wurth S, Baud L, Von Zitzewitz J, van den Brand R, Micera S, Courtine G, Paik J. Rehabilitative Soft Exoskeleton for Rodents. IEEE Trans Neural Syst Rehabil Eng 2016; 25:107-118. [PMID: 28113858 DOI: 10.1109/tnsre.2016.2535352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Robotic exoskeletons provide programmable, consistent and controllable active therapeutic assistance to patients with neurological disorders. Here we introduce a prototype and preliminary experimental evaluation of a rehabilitative gait exoskeleton that enables compliant yet effective manipulation of the fragile limbs of rats. To assist the displacements of the lower limbs without impeding natural gait movements, we designed and fabricated soft pneumatic actuators (SPAs). The exoskeleton integrates two customizable SPAs that are attached to a limb. This configuration enables a 1 N force load, a range of motion exceeding 80 mm in the major axis, and speed of actuation reaching two gait cycles/s. Preliminary experiments in rats with spinal cord injury validated the basic features of the exoskeleton. We propose strategies to improve the performance of the robot and discuss the potential of SPAs for the design of other wearable interfaces.
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Ataollahi A, Berra I, Vasilyev NV, Machaidze Z, Dupont PE. Cardioscopic Tool-delivery Instrument for Beating-heart Surgery. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2016; 21:584-590. [PMID: 26951754 PMCID: PMC4778079 DOI: 10.1109/tmech.2015.2494842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper describes an instrument that provides solutions to two open challenges in beating-heart intracardiac surgery - providing high-fidelity imaging of tool-tissue contact and controlling tool penetration into tissue over the cardiac cycle. Tool delivery is illustrated in the context of tissue removal for which these challenges equate to visualization of the tissue as it is being removed and to control of cutting depth. Cardioscopic imaging is provided by a camera and illumination system encased in an optical window. When the optical window is pressed against tissue, it displaces the blood between the camera and tissue allowing clear visualization. Control of cutting depth is achieved via precise extension of the cutting tool from a port in the optical window. Successful tool use is demonstrated in ex vivo and in vivo experiments.
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Affiliation(s)
- Asghar Ataollahi
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Ignacio Berra
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Nikolay V Vasilyev
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Zurab Machaidze
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
| | - Pierre E Dupont
- A. Ataollahi, I. Berra, N. Vasilyev, Z. Machaidze and P. Dupont are with Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. {first.last}@childrens.harvard.edu
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Bowthorpe M, Tavakoli M, Becher H, Howe R. Smith predictor-based robot control for ultrasound-guided teleoperated beating-heart surgery. IEEE J Biomed Health Inform 2014; 18:157-66. [PMID: 24403413 DOI: 10.1109/jbhi.2013.2267494] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Performing surgery on fast-moving heart structures while the heart is freely beating is next to impossible. Nevertheless, the ability to do this would greatly benefit patients. By controlling a teleoperated robot to continuously follow the heart's motion, the heart can be made to appear stationary. The surgeon will then be able to operate on a seemingly stationary heart when in reality it is freely beating. The heart's motion is measured from ultrasound images and thus involves a non-negligible delay due to image acquisition and processing, estimated to be 150 ms that, if not compensated for, can cause the teleoperated robot's end-effector (i.e., the surgical tool) to collide with and puncture the heart. This research proposes the use of a Smith predictor to compensate for this time delay in calculating the reference position for the teleoperated robot. The results suggest that heart motion tracking is improved as the introduction of the Smith predictor significantly decreases the mean absolute error, which is the error in making the distance between the robot's end-effector and the heart follow the surgeon's motion, and the mean integrated square error.
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Kesner SB, Howe RD. Robotic catheter cardiac ablation combining ultrasound guidance and force control. Int J Rob Res 2014. [DOI: 10.1177/0278364913511350] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac catheters allow physicians to access the inside of the heart and perform therapeutic interventions without stopping the heart or opening the chest. However, conventional manual and actuated cardiac catheters are currently unable to precisely track and manipulate the intracardiac tissue structures because of the fast tissue motion and potential for applying damaging forces. This paper addresses these challenges by proposing and implementing a robotic catheter system that uses 3D ultrasound image guidance and force control to enable constant contact with a moving target surface in order to perform interventional procedures, such as intracardiac tissue ablation. The robotic catheter system, consisting of a catheter module, ablation and force sensing end effector, drive system, and image-guidance and control system, was commanded to apply a constant force against a moving target using a position-modulated force control method. The control system uses a combination of position tracking, force feedback, and friction and backlash compensation to achieve accurate and safe catheter–tissue interactions. The catheter was able to maintain a 1 N force on a moving motion simulator target under ultrasound guidance with 0.08 N RMS error. In a simulated ablation experiment, the robotic catheter was also able to apply a consistent force on the target while maintaining ablation electrode contact with 97% less RMS contact resistance variation than a passive mechanical equivalent. In addition, the use of force control improved catheter motion tracking by approximately 20%. These results demonstrate that 3D ultrasound guidance and force tracking allow the robotic system to maintain improved contact with a moving tissue structure, thus allowing for more accurate and repeatable cardiac procedures.
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Affiliation(s)
- Samuel B. Kesner
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA
| | - Robert D. Howe
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA
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Abstract
With the advent of off-pump and minimally invasive coronary artery bypass grafting, efforts to facilitate construction of the graft to coronary anastomosis have increased. As a result, a number of anastomotic devices have been developed. While the ideal anastomotic device should be easy to use, produce a geometrically optimal anastomosis with minimal endothelial damage and minimal blood-exposed nonintimal surface, a number of design constraints apply. This review collects the available preclinical and clinical data for some of the devices, with special regard as to surgical outcome, patency rate and the need for additional perioperative anticoagulation treatment.
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Affiliation(s)
- Volkmar Falk
- Universität Leipzig Herzzentrum, Klinik für Herzchirurgie, Strümpellstrasse 39, 04289 Leipzig, Germany.
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Kurosawa H, Seto Y, Wakamatsu H, Sato Y, Takase S, Omata S, Yokoyama H. Effects of phenylephrine and noradrenaline on coronary artery motion in an open-chest porcine beating heart model. Surg Today 2013; 44:1128-37. [PMID: 23812899 DOI: 10.1007/s00595-013-0639-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE During off-pump coronary artery bypass (OPCAB), surgeons are required to perform a precise anastomosis on the beating heart. The hypotension caused by vertical displacement of the heart during OPCAB is usually treated with vasopressors, such as noradrenaline and phenylephrine. However, the effects of these agents on coronary artery motion are unknown. The present study analyzed the motion of the target coronary arteries during noradrenaline or phenylephrine infusion using three-dimensional motion capture and reconstruction technology. METHODS The left anterior descending (LAD) artery, left circumflex (LCX) artery and right coronary artery (RCA) of 12 female landrace pigs (weight 50 ± 1 kg) were stabilized using a tissue stabilizer. The motions in the regions were captured before and during noradrenaline (n = 5) and phenylephrine (n = 7) infusion. RESULTS Noradrenaline (0.15 μg/kg/min) and phenylephrine (1.1 μg/kg/min) significantly increased the blood pressure. Noradrenaline significantly increased the motion parameters, such as the distance moved, maximum velocity, acceleration and deceleration at the LAD (4.2 vs. 7.9 mm, P = 0.025; 95.7 vs. 215.5 mm/s, P = 0.0074; 35.3 vs. 83.6 m/s(2), P = 0.0096 and -35.6 vs. -83.6 m/s(2), P = 0.005, respectively). The values during phenylephrine infusion did not change except for the distance moved at the LAD (3.8 vs. 7.7 mm, P = 0.042). The motion parameters at the LCX and RCA during noradrenaline and phenylephrine infusion did not change significantly. CONCLUSIONS The effect of phenylephrine on the coronary artery motion was less dramatic than that of noradrenaline.
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Affiliation(s)
- Hiroyuki Kurosawa
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan,
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Gagne J, Piccin O, Laroche É, Diana M, Gangloff J. GyroLock: Stabilizing the Heart With Control Moment Gyroscope (CMG)—From Concept to First In Vivo Assessments. IEEE T ROBOT 2012. [DOI: 10.1109/tro.2012.2188162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Liu C, Moreira P, Zemiti N, Poignet P. 3D force control for robotic-assisted beating heart surgery based on viscoelastic tissue model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:7054-8. [PMID: 22255963 DOI: 10.1109/iembs.2011.6091783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Current cardiac surgery faces the challenging problem of heart beating motion even with the help of mechanical stabilizer which makes delicate operation on the heart surface difficult. Motion compensation methods for robotic-assisted beating heart surgery have been proposed recently in literature, but research on force control for such kind of surgery has hardly been reported. Moreover, the viscoelasticity property of the interaction between organ tissue and robotic instrument further complicates the force control design which is much easier in other applications by assuming the interaction model to be elastic (industry, stiff object manipulation, etc.). In this work, we present a three-dimensional force control method for robotic-assisted beating heart surgery taking into consideration of the viscoelastic interaction property. Performance studies based on our D2M2 robot and 3D heart beating motion information obtained through Da Vinci™ system are provided.
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Affiliation(s)
- Chao Liu
- Robotics Department, LIRMM - CNRS, Montpellier, France.
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Yuen SG, Perrin DP, Vasilyev NV, Del Nido PJ, Howe RD. Force Tracking with Feed-Forward Motion Estimation for Beating Heart Surgery. IEEE T ROBOT 2010; 26:888-896. [PMID: 29375279 DOI: 10.1109/tro.2010.2053734] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The manipulation of fast moving, delicate tissues in beating heart procedures presents a considerable challenge to the surgeon. A robotic force tracking system can assist the surgeon by applying precise contact forces to the beating heart during surgical manipulation. Standard force control approaches cannot safely attain the required bandwidth for this application due to vibratory modes within the robot structure. These vibrations are a limitation even for single degree of freedom systems driving long surgical instruments. These bandwidth limitations can be overcome by incorporating feed-forward motion terms in the control law. For intracardiac procedures, the required motion estimates can be derived from 3D ultrasound imaging. Dynamic analysis shows that a force controller with feed-forward motion terms can provide safe and accurate force tracking for contact with structures within the beating heart. In vivo validation confirms that this approach confers a 50% reduction in force fluctuations when compared to a standard force controller and a 75% reduction in fluctuations when compared to manual attempts to maintain the same force.
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Affiliation(s)
- Shelten G Yuen
- Harvard School of Engineering and Applied Sciences, Cambridge, MA 02138 USA
| | - Douglas P Perrin
- Department of Cardiovascular Surgery, Children's Hospital Boston, MA 02115 USA
| | - Nikolay V Vasilyev
- Department of Cardiovascular Surgery, Children's Hospital Boston, MA 02115 USA
| | - Pedro J Del Nido
- Department of Cardiovascular Surgery, Children's Hospital Boston, MA 02115 USA
| | - Robert D Howe
- Harvard School of Engineering and Applied Sciences, Cambridge, MA 02138 USA, Harvard-MIT Division of Health Sciences & Technology, Cambridge, MA 02139 USA
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Wakamatsu H, Watanabe T, Sato Y, Takase S, Omata S, Yokoyama H. Selective Beta-1 Receptor Blockade Further Reduces the Mechanically Stabilized Target Coronary Artery Motion during Beating Heart Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hiroki Wakamatsu
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toshiki Watanabe
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshiyuki Sato
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinya Takase
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Sadao Omata
- Department of Electrical and Electronics Engineering, College of Engineering, Nihon University, Koriyama, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Selective beta-1 receptor blockade further reduces the mechanically stabilized target coronary artery motion during beating heart surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:349-54. [PMID: 22437520 DOI: 10.1097/imi.0b013e3181f6536b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adequate stabilization of anastomosis sites during off-pump coronary artery bypass is essential to obtain excellent graft patency. We examined the effect of beta-1 adrenergic receptor blockade on the target coronary artery motion by three-dimensional (3D) digital motion capture and reconstruction technology. METHODS Eight pigs underwent a sternotomy. Reflection markers were attached to the surface coronary arteries, followed by a mechanical stabilizer application. Two high-speed digital cameras captured two-dimensional (2D) motion of the markers from different angles. These 2D data were reconstructed into 3D data points, representing the motion of each coronary artery. Landiolol hydrochloride, a novel selective beta-1 receptor blocker, was infused intravenously after acquisition of control data. RESULTS Beta-1 receptor blockade decreased heart rate (105 ± 16 vs. 90 ± 9 beat/min; P = 0.007) without decreasing arterial blood pressure. The 3D distance moved (millimeter) during one cardiac cycle was significantly reduced on the left anterior descending (9.6 ± 2.8 vs. 6.6 ± 1.9 mm; P = 0.003), left circumflex (10.5 ± 6.3 vs. 6.4 ± 2.6 mm; P = 0.038), and right coronary (8.3 ± 3.6 vs. 6.5 ± 2.1 mm; P = 0.028) arteries. Reduction in the maximal velocity, maximal acceleration, and maximal deceleration of the anastomosis site in all coronary arteries was also found in a quantitative fashion. CONCLUSIONS Selective beta-1 receptor blockade significantly reduces the 3D motion at anastomosis sites on the beating heart, with stable systemic blood pressure. Further quantitative investigations of pharmacological stabilization are warranted to achieve better outcome of the patients undergoing off-pump coronary artery bypass surgery.
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Bogatyrenko E, Pompey P, Hanebeck UD. Efficient physics-based tracking of heart surface motion for beating heart surgery robotic systems. Int J Comput Assist Radiol Surg 2010; 6:387-99. [DOI: 10.1007/s11548-010-0517-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/30/2010] [Indexed: 12/01/2022]
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Yuen SG, Vasilyev NV, del Nido PJ, Howe RD. Robotic tissue tracking for beating heart mitral valve surgery. Med Image Anal 2010; 17:1236-42. [PMID: 23973122 DOI: 10.1016/j.media.2010.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 06/16/2010] [Accepted: 06/21/2010] [Indexed: 11/29/2022]
Abstract
The rapid motion of the heart presents a significant challenge to the surgeon during intracardiac beating heart procedures. We present a 3D ultrasound-guided motion compensation system that assists the surgeon by synchronizing instrument motion with the heart. The system utilizes the fact that certain intracardiac structures, like the mitral valve annulus, have trajectories that are largely constrained to translation along one axis. This allows the development of a real-time 3D ultrasound tissue tracker that we integrate with a 1 degree-of-freedom (DOF) actuated surgical instrument and predictive filter to devise a motion tracking system adapted to mitral valve annuloplasty. In vivo experiments demonstrate that the system provides highly accurate tracking (1.0 mm error) with 70% less error than manual tracking attempts.
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Affiliation(s)
- Shelten G Yuen
- Harvard School of Engineering and Applied Sciences, 29 Oxford Street, Cambridge, MA 02138, USA
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21
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Abstract
The manipulation of fast moving, delicate tissues in beating heart procedures presents a considerable challenge to surgeons. We present a new robotic force stabilization system that assists surgeons by maintaining a constant contact force with the beating heart. The system incorporates a novel, miniature uniaxial force sensor that is mounted to surgical instrumentation to measure contact forces during surgical manipulation. Using this sensor in conjunction with real-time tissue motion information derived from 3D ultrasound, we show that a force controller with feed-forward motion terms can provide safe and accurate force stabilization in an in vivo contact task against the beating mitral valve annulus. This confers a 50% reduction in force fluctuations when compared to a standard force controller and a 75% reduction in fluctuations when compared to manual attempts to maintain the same force.
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Bareeq RA, Jayaraman S, Kiaii B, Schlachta C, Denstedt JD, Pautler SE. The role of surgical simulation and the learning curve in robot-assisted surgery. J Robot Surg 2008; 2:11-5. [DOI: 10.1007/s11701-008-0074-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 03/09/2008] [Indexed: 11/30/2022]
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de Cannière D, Wimmer-Greinecker G, Cichon R, Gulielmos V, Van Praet F, Seshadri-Kreaden U, Falk V. Feasibility, safety, and efficacy of totally endoscopic coronary artery bypass grafting: multicenter European experience. J Thorac Cardiovasc Surg 2007; 134:710-6. [PMID: 17723822 DOI: 10.1016/j.jtcvs.2006.06.057] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 05/16/2006] [Accepted: 06/09/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The invention of robotic systems has begun a new era of endoscopic cardiac surgery. Reports on totally endoscopic coronary artery bypass grafting are limited, however, and data regarding feasibility, safety, and efficacy are needed to determine this technique's position in the therapeutic armamentarium. This study describes the largest multicenter experience in the literature with robotic totally endoscopic coronary artery bypass grafting specifically addressing procedural feasibility, safety, and efficacy. METHODS Between September 1998 and November 2002, a total of 228 patients with coronary artery disease were scheduled for totally endoscopic coronary artery bypass grafting with the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif.) at five European institutions. Patients underwent totally endoscopic coronary artery bypass grafting with either an on-pump (group A, n = 117) or an off-pump approach (group B, n = 111). Patients underwent postoperative angiography or stress electrocardiography and were followed up for 6 months. RESULTS Procedural feasibility was demonstrated through the completion of 164 successful totally endoscopic cases. Sixty-four patients (group C, 28%) had conversion to nonrobotic procedures. Conversion rates decreased with time. The overall procedural efficacy, as defined by angiographic patency or lack of ischemic signs on stress electrocardiography, was 97%. The incidence of major adverse cardiac events within 6 months was 5%. CONCLUSION Both on- and off-pump totally endoscopic coronary artery bypass grafting are feasible, with a conversion rate that diminishes with increasing experience. Conversion does not adversely affect outcome and thus constitutes a safe alternative. Although target vessel reintervention may be slightly higher than that reported for open coronary artery bypass grafting, graft patency and major adverse cardiac events for both approaches are comparable to those reported in the Society of Thoracic Surgeons database, demonstrating the safety and efficacy of the totally endoscopic coronary artery bypass grafting procedure.
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Affiliation(s)
- Didier de Cannière
- Department of Cardiac Surgery at Erasme University Hospital, Brussels, Belgium.
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24
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Bebek O, Cavusoglu MC. Intelligent control algorithms for robotic-assisted beating heart surgery. IEEE T ROBOT 2007. [DOI: 10.1109/tro.2007.895077] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Watanabe T, Omata S, Odamura M, Okada M, Nakamura Y, Yokoyama H. Three-dimensional quantification of cardiac surface motion: a newly developed three-dimensional digital motion-capture and reconstruction system for beating heart surgery. J Thorac Cardiovasc Surg 2006; 132:1162-71. [PMID: 17059939 DOI: 10.1016/j.jtcvs.2006.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 05/17/2006] [Accepted: 07/07/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate our newly developed 3-dimensional digital motion-capture and reconstruction system in an animal experiment setting and to characterize quantitatively the three regional cardiac surface motions, in the left anterior descending artery, right coronary artery, and left circumflex artery, before and after stabilization using a stabilizer. METHODS Six pigs underwent a full sternotomy. Three tiny metallic markers (diameter 2 mm) coated with a reflective material were attached on three regional cardiac surfaces (left anterior descending, right coronary, and left circumflex coronary artery regions). These markers were captured by two high-speed digital video cameras (955 frames per second) as 2-dimensional coordinates and reconstructed to 3-dimensional data points (about 480 xyz-position data per second) by a newly developed computer program. RESULTS The remaining motion after stabilization ranged from 0.4 to 1.01 mm at the left anterior descending, 0.91 to 1.52 mm at the right coronary artery, and 0.53 to 1.14 mm at the left circumflex regions. Significant differences before and after stabilization were evaluated in maximum moving velocity (left anterior descending 456.7 +/- 178.7 vs 306.5 +/- 207.4 mm/s; right coronary artery 574.9 +/- 161.7 vs 446.9 +/- 170.7 mm/s; left circumflex 578.7 +/- 226.7 vs 398.9 +/- 192.6 mm/s; P < .0001) and maximum acceleration (left anterior descending 238.8 +/- 137.4 vs 169.4 +/- 132.7 m/s2; right coronary artery 315.0 +/- 123.9 vs 242.9 +/- 120.6 m/s2; left circumflex 307.9 +/- 151.0 vs 217.2 +/- 132.3 m/s2; P < .0001). CONCLUSIONS This system is useful for a precise quantification of the heart surface movement. This helps us better understand the complexity of the heart, its motion, and the need for developing a better stabilizer for beating heart surgery.
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Affiliation(s)
- Toshiki Watanabe
- Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan.
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Shapira OM, Eskenazi BR, Hunter CT, Korach A, Anter E, Lazar HL, Shemin RJ. Dual-Beam Ultrasound versus Transit-Time Flow Meter for Intraoperative Graft Flow Measurement during Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006. [DOI: 10.1177/155698450600100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Oz M. Shapira
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
| | | | - Curtis T. Hunter
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
| | - Amit Korach
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
| | - Elad Anter
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
| | - Harold L. Lazar
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
| | - Richard J. Shemin
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
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Dual-Beam Ultrasound versus Transit-Time Flow Meter for Intraoperative Graft Flow Measurement during Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006; 1:131-6. [DOI: 10.1097/01243895-200600130-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Assessment of graft flow during coronary artery bypass grafting (CABG) is increasingly practiced as a quality measure, particularly in patients undergoing minimally invasive or “off-pump” revascularization. Transit-time flow meters such as Transonic system (TS) are currently the most frequently used technology. The QuantixOR flow probe (QOR) is a novel technology comprised of dual-beam ultrasound transducer and a digital pulse-wave Doppler, allowing immediate, quantitative blood flow measurements. Excellent correlation between QOR and TS was observed in phantom and animal models. This study evaluated the QOR in patients undergoing CABG. Methods Graft flow was measured in 75 patients undergoing CABG (203 grafts). Intraobserver (n = 169) and interobserver (n = 33) variability was assessed and the QOR was compared with the TS (n = 155). Results An average of 2 probe sizes per case and “skeletonization” of a short segment of the vessel were required to measure flow in arterial conduits using TS. In contrast, measurements of flow with the QOR were achieved using a single probe without special vessel preparation for all types of conduits. Average intraobserver and interobserver variability using the QOR were 5 ± 41% and 4 ± 40%, respectively. Correlation was observed between 2 sets of measurements by the same observer (R2 = 0.746, P < 0.0001) and between 2 different observers (R2 = 0.667, P < 0.0001). Correlation was also observed between the QOR and TS (R2 = 0.542, P < 0.0001) with a variance of 12 ± 21%. Conclusions The QOR technology provides a reliable quantitative graft flow assessment that is simpler to obtain compared with TS. Correlation between the QOR and TS is excellent.
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Galiñanes M. Nuevas expectativas en la revascularización miocárdica quirúrgica. Rev Esp Cardiol (Engl Ed) 2005. [DOI: 10.1016/s0300-8932(05)74076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ortmaier T, Gröger M, Boehm DH, Falk V, Hirzinger G. Motion estimation in beating heart surgery. IEEE Trans Biomed Eng 2005; 52:1729-40. [PMID: 16235658 DOI: 10.1109/tbme.2005.855716] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive beating-heart surgery offers substantial benefits for the patient, compared to conventional open surgery. Nevertheless, the motion of the heart poses increased requirements to the surgeon. To support the surgeon, algorithms for an advanced robotic surgery system are proposed, which offer motion compensation of the beating heart. This implies the measurement of heart motion, which can be achieved by tracking natural landmarks. In most cases, the investigated affine tracking scheme can be reduced to an efficient block matching algorithm allowing for realtime tracking of multiple landmarks. Fourier analysis of the motion parameters shows two dominant peaks, which correspond to the heart and respiration rates of the patient. The robustness in case of disturbance or occlusion can be improved by specially developed prediction schemes. Local prediction is well suited for the detection of single tracking outliers. A global prediction scheme takes several landmarks into account simultaneously and is able to bridge longer disturbances. As the heart motion is strongly correlated with the patient's electrocardiogram and respiration pressure signal, this information is included in a novel robust multisensor prediction scheme. Prediction results are compared to those of an artificial neural network and of a linear prediction approach, which shows the superior performance of the proposed algorithms.
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Affiliation(s)
- Tobias Ortmaier
- German Aerospace Center (DLR), Institute of Robotics and Mechatronics, Oberpfaffenhofen, 82234 Wessling, Germany.
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Falk V, Walther T, Jacobs S, Wolf RK, Mohr FW. Facilitated MIDCAB using a magnetic coupling device. Ann Thorac Surg 2005; 79:691-3. [PMID: 15680865 DOI: 10.1016/s0003-4975(03)01403-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2003] [Indexed: 10/25/2022]
Abstract
A 59-year-old male with chronic occlusion of the left anterior descending coronary artery underwent a minimally invasive direct coronary artery bypass procedure using the second generation of a magnetic anastomotic coupling device. Postoperative angiogram demonstrated excellent patency and flow.
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Affiliation(s)
- Volkmar Falk
- Department of Cardiac Surgery, Heartcenter, University of Leipzig, Germany
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Falk V, Mourgues F, Adhami L, Jacobs S, Thiele H, Nitzsche S, Mohr FW, Coste-Manière E. Cardio Navigation: Planning, Simulation, and Augmented Reality in Robotic Assisted Endoscopic Bypass Grafting. Ann Thorac Surg 2005; 79:2040-7. [PMID: 15919306 DOI: 10.1016/j.athoracsur.2004.11.060] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Revised: 11/04/2004] [Accepted: 11/10/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study is to optimize the set-up and port placement in robotic surgery and enhance intraoperative orientation by video overlay of the angiographic coronary tree. METHODS In three mongrel dogs and two sheep an electrocardiogram-triggered computed tomographic scan and coronary angiography were performed after placing cutaneous fiducials. The regions of interest (ie, heart, ribs, coronaries, internal thoracic artery) were segmented semiautomatically to create a virtual model of the animal. In this model the target regions of the total endoscopic bypass procedure along the internal thoracic artery and anastomotic area were defined. Algorithms for weighing visibility, dexterity, and collision avoidance were calculated after defining nonadmissible areas using a virtual model of the manipulator. Intraoperatively, registration of the animal and the telemanipulator was performed using encoder data of the telemanipulator by pointing to the fiducials. After pericardiotomy, the reconstructed coronary tree was projected into the videoscopic image using a semiautomatic alignment procedure. In dogs, the total endoscopic bypass procedure was completed on the beating heart. The first human case applying preoperative planning, intraoperative registration, and augmented reality was subsequently performed. RESULTS The rigid transformation linked the patient's preoperative frame and the robot coordinate frame with a root mean square error of 9 to 15 mm. The predicted port placement derived from the model initially varied from the one chosen due to an incomplete formulation of the weighing procedure. After only a few iterations, the algorithm became robust and predicted a collision free triangle. Video overlay of the angiographic coronary tree into the videoscopic image was feasible. CONCLUSIONS Surgical planning and augmented reality are likely to enhance robotic surgery in the future. A more complete understanding of the surgical decision process is required to better formalize the planning algorithms.
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Affiliation(s)
- Volkmar Falk
- Herzzentrum, Klinik für Herzchirurgie, Leipzig, Germany.
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Falk V, Walther T, Stein H, Jacobs S, Walther C, Rastan A, Wimmer-Greinecker G, Mohr FW. Facilitated endoscopic beating heart coronary artery bypass grafting using a magnetic coupling device. J Thorac Cardiovasc Surg 2004; 126:1575-9. [PMID: 14666035 DOI: 10.1016/s0022-5223(03)00793-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. The potential benefits of the endoscopic Magnetic Vascular Positioner device (Ventrica, Inc, Fremont, Calif) to facilitate construction of a coronary anastomosis in a closed chest environment were evaluated. METHODS Totally endoscopic coronary artery bypass grafting on the beating heart was performed in 8 foxhound-beagle inbred dogs with the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, Calif). A prototype of the endoscopic Magnetic Vascular Positioner device was used to facilitate construction of the coronary anastomosis. One pair of magnets was inserted in the internal thoracic artery and left anterior descending artery using robotic instruments to guide and place the endoscopic delivery platform. All animals underwent angiography; gross inspection of the anastomotic site was performed after excision of the hearts. RESULTS The procedure was accomplished in all animals in 169 minutes (155-190 minutes). Dissection of the left anterior descending coronary artery (6.5 minutes; 1-20 minutes), positioning of the stabilizer (8.5 minutes; 7-16 minutes), placement of occlusion tapes (6 minutes, 3-10 minutes), and arteriotomy 5.5 minutes (3-30 minutes) was achieved without problems. By use of the Magnetic Vascular Positioner device, the anastomosis at the graft site was performed with the graft still in situ. Except for 1 premature deployment, all other deployments were easily accomplished in 3 minutes (1-28 minutes). The following adverse events were encountered: bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage on reperfusion requiring repair stitches (2), and anastomotic occlusion as a result of thrombus (1). All except 1 animal with a patent graft and anastomosis survived the procedure. The overall patency was 7 of 8. DISCUSSION The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and a simple yet effective and timesaving technique for anastomotic coupling may facilitate beating heart totally endoscopic coronary artery bypass grafting.
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Affiliation(s)
- Volkmar Falk
- Department of Cardiac Surgery, Heartcenter, University of Leipzig, Germany.
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Falk V, Jacobs S, Gummert J, Walther T. Robotic coronary artery bypass grafting (CABG)—the Leipzig experience. Surg Clin North Am 2003; 83:1381-6, ix. [PMID: 14712873 DOI: 10.1016/s0039-6109(03)00165-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technical and anatomical limitations as well as human factors complicate endoscopic coronary bypass surgery. Computer-enhanced telemanipulation systems overcome some of these shortcomings by restoring the dexterity and precision of a distant operator (surgeon) within a confined space. Endoscopic coronary artery bypass grafting (CABG) has evolved from a merely experimental approach to a clinical concept. Although CABG was initially exclusively performed on the arrested heart, adjunct technologies such as endoscopic vacuum-assisted stabilizers now allow a closed-chest, beating-heart procedure. The development of anastomotic devices, and further refinements in telemanipulator technology, optical systems, and image-guided augmented-reality scenarios will greatly facilitate endoscopic bypass grafting in the future.
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Affiliation(s)
- Volkmar Falk
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
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Jacobs S, Holzhey D, Kiaii BB, Onnasch JF, Walther T, Mohr FW, Falk V. Limitations for manual and telemanipulator-assisted motion tracking—implications for endoscopic beating-heart surgery. Ann Thorac Surg 2003; 76:2029-35; discussion 2035-6. [PMID: 14667635 DOI: 10.1016/s0003-4975(03)01058-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical performance is limited by human factors. Beating-heart surgery requires full dexterity and motion tracking. Currently techniques for total endoscopic beating-heart bypass grafting using telemanipulation systems are being developed. The aim of this study was to assess the limitations for manual and telemanipulator-assisted motion tracking using the da Vinci telemanipulator system. METHODS To simulate beating-heart conditions an endoscopic trainer was developed. Twenty subjects were asked to touch targets manually and with telemanipulator assistance with different patterns of increasing index of difficulty (resting model, unstabilized, and stabilized model with a frequency of 35, 60, and 90 beats per minute). In addition one task was performed using different scaling ratios on a resting model. The times between hits as well as errors were electronically recorded. RESULTS There was no significant impact of various frequencies and amplitudes for manual tracking. The average values for the delay (k(m)[ms]) and information-processing (c(m) [ms/bit]) constants for the manual tasks were 201 ms and 86 ms/bit respectively. Both the delay constant (k(t) = 630 ms; p < 0.0005) and the information-processing constant (c(t) = 250 ms/bit; p < 0.0005) were increased for the telemanipulator-assisted tasks at rest. When working on moving targets telemanipulator-assisted tracking required significantly more time and led to more errors. At a frequency of 90 beats per minute telemanipulator-assisted tracking became more difficult. CONCLUSIONS Endoscopic beating-heart bypass grafting requires optimal stabilization to avoid inaccuracies due to incomplete motion tracking. At higher frequencies telemanipulator-assisted tracking became more difficult, demonstrating the technical limits of current telemanipulator technology.
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Affiliation(s)
- Stephan Jacobs
- Department of Cardiac Surgery, Heartcenter, University of Leipzig, Leipzig, Germany.
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Athanasiou T, Kumar P, Al-Ruzzeh S, Aziz O, Charitou A, Hart J, Glenville B, Casula R. Expanded use of suction and stabilization devices in cardiothoracic surgery. Ann Thorac Surg 2003; 76:1126-30. [PMID: 14529998 DOI: 10.1016/s0003-4975(03)00815-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent developments in beating heart instrumentation have allowed surgeons to perform multivessel off-pump coronary artery bypass surgery by overcoming the factors that impair surgical performance (limited visualization, continuous movement of the target area, and hemodynamic instability during exposure of the inferior and posterior parts of the heart). We have explored the possibility of further expanding apical and epicardial suction devices beyond their ordinary use in coronary artery surgery. METHODS A retrospective review of our cardiac surgery database was undertaken to identify the incidences in which these devices have been used in a somewhat novel manner in the field of cardiac surgery. RESULTS During this time period we identified 20 instances in which either apical or epicardial suction devices were used alone or together. The nature of the procedures included dividing pericardial adhesions (pericardiectomy, n = 2; dividing adhesions in redo-coronary surgery, n = 4), securing epicardial hemostasis (penetrating cardiac trauma, n = 2; securing hemostasis during reexploration after cardiac surgery, n = 10), and facilitating epicardial microwave ablation (n = 2). On all 20 occasions the intended procedures were undertaken uneventfully. Furthermore, the use of apical and epicardial devices greatly facilitated the operative procedures and avoided the use of cardiopulmonary bypass on all occasions. CONCLUSIONS In summary, we would like to highlight the expanding role for apical and epicardial suction devices to an area beyond coronary artery surgery in which we have found their use invaluable.
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Affiliation(s)
- Thanos Athanasiou
- The National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, England, London, United Kingdom.
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Boyd WD, Stahl KD. The janus syndrome: a perspective on a new era of computer-enhanced robotic cardiac surgery. J Thorac Cardiovasc Surg 2003; 126:625-30. [PMID: 14502130 DOI: 10.1016/s0022-5223(02)73573-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Falk V, Jacobs S, Gummert JF, Walther T, Mohr FW. Computer-enhanced endoscopic coronary artery bypass grafting: the da Vinci experience. Semin Thorac Cardiovasc Surg 2003. [DOI: 10.1016/s1043-0679(03)70018-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stein H, Ikeda M, Jacobs S, Lilagan P, Walther C, Rastan A, Mohr FW, Falk V. Telemanipulator-gestützte Applikation eines magnetischen Gefäß-Kopplers am schlagenden Herzen mit dem daVinci™-Surgical-System. Telemanipulatory Application of a Magnetic Vascular Coupler on the Beating Heart with the daVinci™ surgical System. BIOMED ENG-BIOMED TE 2003; 48:230-4. [PMID: 14526450 DOI: 10.1515/bmte.2003.48.9.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The construction of a coronary anastomosis on the beating heart under totally endoscopic conditions is technically demanding. In this study the potential benefits of an endoscopic magnetic vascular coupler (MVP, Ventrica, Inc, Fremont, CA) designed to facilitate construction of a coronary anastomosis with the help of the daVinci telemanipulator (Intuitive Surgical Inc., Sunnyvale, CA) were evaluated in a totally endoscopic coronary arterial bypass (TECAB) operation on the beating heart in eight dogs. The telemanipulated instruments were used to guide and place the endoscopic MVP-application platform (prototype). All animals underwent angiography, and gross inspection of the anastomotic site was done after excision of the hearts. The procedure was accomplished in 169 minutes (155-190). With the exception of one premature deployment, all MVP-anastomoses were accomplished in 3 minutes (1-28). The following adverse events were encountered: Bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage upon reperfusion requiring repair stitches (2), anastomotic occlusion due to a thrombus (1). All but one animal that died on reperfusion despite a patent graft and anastomosis, survived the procedure. Overall patency was 7 out of 8. The combination of telemanipulator technology allowing increased manipulation dexterity in a total endoscopic environment and the effective and time saving magnetic technique for anastomotic coupling has the potential to facilitate TECAB on the beating heart.
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Affiliation(s)
- H Stein
- Department of Clinical Development Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA.
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