1
|
Cheng L, Tavakoli M. Neural network-based physiological organ motion prediction and robot impedance control for teleoperated beating-heart surgery. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
2
|
Cheng L, Sharifi M, Tavakoli M. Towards robot-assisted anchor deployment in beating-heart mitral valve surgery. Int J Med Robot 2018; 14:e1900. [DOI: 10.1002/rcs.1900] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Lingbo Cheng
- Department of Electrical and Computer Engineering; University of Alberta; Edmonton Alberta Canada
| | - Mojtaba Sharifi
- Department of Mechanical Engineering; Shiraz University; Shiraz Iran
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering; University of Alberta; Edmonton Alberta Canada
| |
Collapse
|
3
|
Kotlinska-Hasiec E, Czajkowski M, Rzecki Z, Stadnik A, Olszewski K, Rybojad B, Dabrowski W. Disturbance in Venous Outflow From the Cerebral Circulation Intensifies the Release of Blood-Brain Barrier Injury Biomarkers in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:328-35. [DOI: 10.1053/j.jvca.2013.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Indexed: 02/06/2023]
|
4
|
Stoll J, Ren H, Dupont PE. Passive markers for tracking surgical instruments in real-time 3-D ultrasound imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2012; 31:563-575. [PMID: 22042148 PMCID: PMC3638948 DOI: 10.1109/tmi.2011.2173586] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A family of passive echogenic markers is presented by which the position and orientation of a surgical instrument can be determined in a 3-D ultrasound volume, using simple image processing. Markers are attached near the distal end of the instrument so that they appear in the ultrasound volume along with the instrument tip. They are detected and measured within the ultrasound image, thus requiring no external tracking device. This approach facilitates imaging instruments and tissue simultaneously in ultrasound-guided interventions. Marker-based estimates of instrument pose can be used in augmented reality displays or for image-based servoing. Design principles for marker shapes are presented that ensure imaging system and measurement uniqueness constraints are met. An error analysis is included that can be used to guide marker design and which also establishes a lower bound on measurement uncertainty. Finally, examples of marker measurement and tracking algorithms are presented along with experimental validation of the concepts.
Collapse
Affiliation(s)
- Jeffrey Stoll
- Ultrasound Division, Siemens Healthcare, Mountain View, CA 94043, USA.
| | | | | |
Collapse
|
5
|
Dabrowski W, Rzecki Z, Pilat J, Czajkowski M. Brain damage in cardiac surgery patients. Curr Opin Pharmacol 2012; 12:189-94. [PMID: 22325856 DOI: 10.1016/j.coph.2012.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 01/19/2012] [Accepted: 01/21/2012] [Indexed: 01/03/2023]
Abstract
Neuropsychological disorders and brain injury are still a serious problem in cardiac surgery patients. Owing to multifactorial mechanism of brain injury during extracorporeal circulation, the effective and safe protection is extremely difficult. Despite several studies, the ideal neuroprotective treatment has not been found. Based on literature we analysed the main mechanisms of brain injury and new methods of brain protection.
Collapse
Affiliation(s)
- Wojciech Dabrowski
- Department of Anaesthesiology Intensive Therapy, Medical University of Lublin, Poland.
| | | | | | | |
Collapse
|
6
|
Lang N, Kozlik-Feldmann R, Meyer-Gold A, Fuchs F, Lehner A, Abicht J, Sodian R, Vasilyev N, del Nido P, Netz H, Reichart B, Schmitz C. Modification of a Hybrid Technique for Closure of Muscular Ventricular Septal Defects in a Pig Model. Heart Surg Forum 2010; 13:E299-304. [DOI: 10.1532/hsf98.20091181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
7
|
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.
Collapse
Affiliation(s)
- Shelten G Yuen
- Harvard School of Engineering and Applied Sciences, 29 Oxford Street, Cambridge, MA 02138, USA
| | | | | | | |
Collapse
|
8
|
Lang N, Schmitz C, Lehner A, Fuchs F, Heath A, Freudenthal F, Wintersperger BJ, Huber AM, Thein E, Netz H, Kozlik-Feldmann R. Preclinical evaluation of a new self-expanding device for closure of muscular ventricular septal defects in a pig model. Catheter Cardiovasc Interv 2010; 75:408-15. [PMID: 19882712 DOI: 10.1002/ccd.22285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Aim of our study was the preclinical evaluation of a new self expanding device for interventional closure of muscular ventricular septal defects (mVSDs) in an acute pig model. BACKGROUND Devices currently in use for closure of mVSDs still have their limitations. The deployment of the disks is dependent from the expansion of the stent, which can be associated with problems for sufficient closure of the mVSDs. This was the reason for developing a modified device with only one disk MATERIALS AND METHODS The device was constructed in a single wire technique with a unique configured retention disk. mVSDs were created in six pigs with a specially designed punch instrument, and subsequently closed with our new device during the same session using a jugular or femoral vein approach. Potential residual shunting volumes were estimated by echocardiography and hemodynamic measurements. After closure, animals were sacrificed, and hearts were harvested for macropathologic evaluation. In two animals, MRI was performed for additional noninvasive evaluation. RESULTS Devices were successfully implanted in all animals with good alignment of the disk to the left ventricular septum, even if the stent was oversized. Echocardiography, hemodynamics, angiography and macropathology revealed complete closure of all mVSDs. MRI and echocardiography showed a good visibility of the device. CONCLUSIONS Our preclinical study shows successful closure of iatrogenic created mVSDs without residual shunting. The device is characterized by a more controlled deployment, an independent deployment of disk and waist, and a good alignment of the left ventricular disk to the muscular septum.
Collapse
Affiliation(s)
- Nora Lang
- Department of Pediatric Cardiology, University Hospital of Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Kozlik-Feldmann R, Lang N, Lehner A, Sigler M, Schmitz C, Sodian R, Freudenthal F, Dalla-Pozza R, Vasilyev NV, del Nido PJ, Netz H. Evaluation of a new hybrid technique for closure of muscular ventricular septal defects in a long-term setting. J Thorac Cardiovasc Surg 2009; 138:365-73. [DOI: 10.1016/j.jtcvs.2009.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 01/11/2009] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
|
10
|
Yuen SG, Kettler DT, Novotny PM, Plowes RD, Howe RD. Robotic Motion Compensation for Beating Heart Intracardiac Surgery. Int J Rob Res 2009; 28:1355-1372. [PMID: 20436927 DOI: 10.1177/0278364909104065] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
3D ultrasound imaging has enabled minimally invasive, beating heart intracardiac procedures. However, rapid heart motion poses a serious challenge to the surgeon that is compounded by significant time delays and noise in 3D ultrasound. This paper investigates the concept of using a one-degree-of-freedom motion compensation system to synchronize with tissue motions that may be approximated by 1D motion models. We characterize the motion of the mitral valve annulus and show that it is well approximated by a 1D model. The subsequent development of a motion compensation instrument (MCI) is described, as well as an extended Kalman filter (EKF) that compensates for system delays. The benefits and robustness of motion compensation are tested in user trials under a series of non-ideal tracking conditions. Results indicate that the MCI provides an approximately 50% increase in dexterity and 50% decrease in force when compared with a solid tool, but is sensitive to time delays. We demonstrate that the use of the EKF for delay compensation restores performance, even in situations of high heart rate variability. The resulting system is tested in an in vitro 3D ultrasound-guided servoing task, yielding accurate tracking (1.15 mm root mean square) in the presence of noisy, time-delayed 3D ultrasound measurements.
Collapse
Affiliation(s)
- Shelten G Yuen
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | | | | | | | | |
Collapse
|
11
|
Kozlik-Feldmann R, Lang N, Aumann R, Lehner A, Rassoulian D, Sodian R, Schmitz C, Hinterseer M, Hinkel R, Thein E, Freudenthal F, Vasilyev NV, Vasylev NV, del Nido PJ, Netz H. Patch closure of muscular ventricular septal defects with a new hybrid therapy in a pig model. J Am Coll Cardiol 2008; 51:1597-603. [PMID: 18420104 DOI: 10.1016/j.jacc.2007.10.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 10/10/2007] [Accepted: 10/23/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We evaluated a novel technique for hybrid patch closure of muscular ventricular septal defects (mVSDs) without cardiopulmonary bypass (CPB) in a pig model. BACKGROUND So far, surgical and interventional therapies for mVSDs have been associated with significant morbidity, especially in newborns and infants. Thus, it is essential to develop new techniques. Hybrid therapy is an innovative approach for mVSDs that combines the advantages of surgical and interventional techniques. METHODS Six pigs underwent left anterolateral thoracotomy to expose the left ventricle (LV). The mVSDs were created under echocardiographic guidance with a 7.5-mm sharp punch instrument that was forwarded via an LV incision. A special designed patch system composed of a patch with a Nitinol frame was passed across the carotid artery into the LV and positioned in front of the mVSD. An instrument resembling a stapler was introduced across the LV wall on the beating heart without use of CPB. The patch was fixed with Nitinol anchors on the septum under echocardiographic and fluoroscopic guidance. Finally, the Nitinol frame was detached from the patch. RESULTS The locations of the defects were apical (n = 1), midmuscular (n = 3), and anterior muscular (n = 2). Closure of the mVSD was successful in 5 of 6 animals confirmed by echocardiography, hemodynamic measurements, and explantation of the heart. Animals were hemodynamically stable throughout the experiment. CONCLUSIONS Here, we present a novel technique for hybrid closure of mVSDs without use of CPB. Further development of the patch system is necessary to assess applicability in humans, especially for the target group of newborns and infants.
Collapse
|
12
|
Novotny PM, Kettler DT, Jordan P, Dupont PE, del Nido PJ, Howe RD. Stereo display of 3D ultrasound images for surgical robot guidance. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:1509-12. [PMID: 17946048 DOI: 10.1109/iembs.2006.259486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The recent advent of real-time 3-D ultrasound (3DUS) imaging enables a variety of surgical procedures to be performed within the beating heart. Implementation of these procedures is hampered by the difficulty of manipulating tissue guided by the distorted, low resolution 3DUS images and the dexterity constraints imposed by the confined intracardiac space. This paper investigates the use of surgical robotics in conjunction with 3DUS to overcome these limitations. In addition, it describes the development of a graphics processor based volume Tenderer for real-time stereo visualization of the ultrasound data. Stereo displayed 3DUS was compared to ID-displayed 3DUS and endoscopic guidance with a user study. Five subjects performed in vitro surgical tasks using a surgical robot. Results indicate that subjects were able to complete surgical tasks 35 % faster with stereo-displayed 3DUS images compared to conventional two dimensional display of 3DUS.
Collapse
Affiliation(s)
- Paul M Novotny
- Division of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | | | | | | | | |
Collapse
|
13
|
Kozlik-Feldmann R, Lang N, Sodian R, Aumann R, Rassoulian D, Hinterseer M, Schmitz C, Netz H. Creation of ventricular septal defects on the beating heart in a new pig model. Eur Surg Res 2008; 40:297-303. [PMID: 18285690 DOI: 10.1159/000117635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 10/29/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS So far, surgical and interventional therapies for muscular ventricular septal defects (mVSDs) beyond the moderator band have had their limitations. Thus, alternative therapeutic strategies should be developed. We present a new animal model for the evaluation of such strategies. METHODS In a pig model (n = 9), anterolateral thoracotomy was performed for exposure of the left ventricle. mVSDs were created under two- and three-dimensional echocardiography with a 7.5-mm sharp punch instrument, which was forwarded via a left ventricular puncture without extracorporeal circulation. RESULTS Creation of mVSDs was successful in all animals (n = 9) confirmed by echocardiography, hemodynamic measurements and autopsy. The defects were located in the midmuscular (n = 4), apical (n = 1), inlet (n = 2) and anterior part (n = 2) of the muscular septum. All animals were hemodynamically stable for further procedures. The diameter and shunt volume of the mVSDs were 4.8-7.3 mm (mean: 5.9 mm) and 12.9-41.3% (mean: 22.1%), respectively. Autopsy confirmed in all animals the creation of a substantial defect. CONCLUSION The described new technique for creation of an mVSD on the beating heart in a pig model is suitable for the evaluation of new therapeutic strategies for mVSD closure.
Collapse
Affiliation(s)
- R Kozlik-Feldmann
- Department of Pediatric Cardiology, University Hospital Grosshadern, Ludwig Maximilian University, Munich, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Linte CA, Wiles AD, Moore J, Wedlake C, Peters TM. Surgical accuracy under virtual reality-enhanced ultrasound guidance: an in vitro epicardial dynamic study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2008; 2008:62-65. [PMID: 19162594 DOI: 10.1109/iembs.2008.4649091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In the context of our ongoing objective to reduce morbidity associated with cardiac interventions, minimizing invasiveness has inevitably led to more limited visual access to the target tissues. To ameliorate these challenges, we provide the surgeons with a complex visualization environment that integrates interventional ultrasound imaging augmented with pre-operative anatomical models and virtual surgical instruments within a virtual reality environment. In this paper we present an in vitro study on a cardiac phantom aimed at assessing the feasibility and targeting accuracy of our surgical system in comparison to traditional ultrasound imaging for intra-operative surgical guidance. The 'therapy delivery' was modeled in the context of a blinded procedure, mimicking a closed-chest intervention. Four users navigated a tracked pointer to a target, under guidance provide by either US imaging or virtual reality-enhanced ultrasound. A 2.8 mm RMS targeting error was achieved using our novel surgical system, which is adequate from both a clinical and engineering perspective, under the inherent procedure requirements and limitations of the system.
Collapse
Affiliation(s)
- Cristian A Linte
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | | | | | | | | |
Collapse
|
15
|
Linte CA, Wierzbicki M, Moore J, Guiraudon G, Jones DL, Peters TM. On Enhancing Planning and Navigation of Beating-Heart Mitral Valve Surgery Using Pre-operative Cardiac Models. ACTA ACUST UNITED AC 2007; 2007:475-8. [DOI: 10.1109/iembs.2007.4352326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Novotny PM, Stoll JA, Vasilyev NV, del Nido PJ, Dupont PE, Zickler TE, Howe RD. GPU based real-time instrument tracking with three-dimensional ultrasound. Med Image Anal 2007; 11:458-64. [PMID: 17681483 PMCID: PMC2693901 DOI: 10.1016/j.media.2007.06.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 06/04/2007] [Indexed: 11/20/2022]
Abstract
Real-time three-dimensional ultrasound enables new intracardiac surgical procedures, but the distorted appearance of instruments in ultrasound poses a challenge to surgeons. This paper presents a detection technique that identifies the position of the instrument within the ultrasound volume. The algorithm uses a form of the generalized Radon transform to search for long straight objects in the ultrasound image, a feature characteristic of instruments and not found in cardiac tissue. When combined with passive markers placed on the instrument shaft, the full position and orientation of the instrument is found in 3D space. This detection technique is amenable to rapid execution on the current generation of personal computer graphics processor units (GPU). Our GPU implementation detected a surgical instrument in 31 ms, sufficient for real-time tracking at the 25 volumes per second rate of the ultrasound machine. A water tank experiment found instrument orientation errors of 1.1 degrees and tip position errors of less than 1.8mm. Finally, an in vivo study demonstrated successful instrument tracking inside a beating porcine heart.
Collapse
Affiliation(s)
- Paul M Novotny
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Novotny PM, Stoll JA, Vasilyev NV, del Nido PJ, Dupont PE, Howe RD. GPU Based Real-Time Instrument Tracking with Three Dimensional Ultrasound. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION – MICCAI 2006 2006; 9:58-65. [PMID: 17354874 DOI: 10.1007/11866565_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Real-time 3D ultrasound can enable new image-guided surgical procedures, but high data rates prohibit the use of traditional tracking techniques. We present a new method based on the modified Radon transform that identifies the axis of instrument shafts as bright patterns in planar projections. Instrument rotation and tip location are then determined using fiducial markers. These techniques are amenable to rapid execution on the current generation of personal computer graphics processor units (GPU). Our GPU implementation detected a surgical instrument in 31 ms, sufficient for real-time tracking at the 26 volumes per second rate of the ultrasound machine. A water tank experiment found instrument tip position errors of less than 0.2 mm, and an in vivo study tracked an instrument inside a beating porcine heart. The tracking results showed good correspondence to the actual movements of the instrument.
Collapse
Affiliation(s)
- Paul M Novotny
- Division of Engineering and Applied Sciences, Harvard University, MA, USA
| | | | | | | | | | | |
Collapse
|
18
|
Novotny PM, Jacobsen SK, Vasilyev NV, Kettler DT, Salgo IS, Dupont PE, Del Nido PJ, Howe RD. 3D ultrasound in robotic surgery: performance evaluation with stereo displays. Int J Med Robot 2006; 2:279-85. [PMID: 17520643 DOI: 10.1002/rcs.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The recent advent of real-time 3D ultrasound (3DUS) imaging enables a variety of new surgical procedures. These procedures are hampered by the difficulty of manipulating tissue guided by the distorted, low-resolution 3DUS images. To lessen the effects of these limitations, we investigated stereo displays and surgical robots for 3DUS-guided procedures. METHODS By integrating real-time stereo rendering of 3DUS with the binocular display of a surgical robot, we compared stereo-displayed 3DUS with normally displayed 3DUS. To test the efficacy of stereo-displayed 3DUS, eight surgeons and eight non-surgeons performed in vitro tasks with the surgical robot. RESULTS Error rates dropped by 50% with a stereo display. In addition, subjects completed tasks faster with the stereo-displayed 3DUS as compared to normal-displayed 3DUS. A 28% decrease in task time was seen across all subjects. CONCLUSIONS The results highlight the importance of using a stereo display. By reducing errors and increasing speed, it is an important enhancement to 3DUS-guided robotics procedures.
Collapse
Affiliation(s)
- Paul M Novotny
- Division of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Suematsu Y, Martinez JF, Wolf BK, Marx GR, Stoll JA, DuPont PE, Howe RD, Triedman JK, del Nido PJ. Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass: atrial septal defect closure in a swine model. J Thorac Cardiovasc Surg 2005; 130:1348-57. [PMID: 16256788 DOI: 10.1016/j.jtcvs.2005.06.043] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 06/20/2005] [Accepted: 06/28/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we tested 3 techniques of atrial septal defect closure under real-time 3-dimensional echocardiography guidance in a swine model. METHODS The operations were conducted under the sole guidance of a modified real-time 3-dimensional echocardiography guidance system with a x4 matrix transducer (Sonos 7500, Philips Medical Systems, Andover, Mass). Eighteen swine were anesthetized, and after median sternotomy, the echo probe was applied directly to the surface of the right atrium. To create an atrial septal defect, balloon atrial septostomy and atrial septal defect enlargement were performed. Subsequently, 3 different techniques of atrial septal defect closure were attempted: group I, direct suture closure; group II, closure of the atrial septal defect using the Amplatzer device (AGA Medical Corp, Golden Valley, Minn); and group III, patch closure of the atrial septal defect (n = 6 each). RESULTS Real-time 3-dimensional echocardiography guidance provided sufficient spatial resolution and a satisfactory frame rate to provide a "virtual surgeon's view" of the relevant anatomy during the entire procedure. All atrial septal defects were enlarged, and the mean final size was 8.5 +/- 1.8 mm. Atrial septal defect closure was successfully accomplished with all the 3 surgical techniques examined. In groups I and III, the needles (1-3 sutures) and staples (6-12 staples) penetrated the tissue and patch material consistently, whereas in group III, the Amplatzer atrial septal defect device was easily deployed. There was no incident device/staple embolization or air introduction. Neither intraoperative 2-dimensional color Doppler echocardiography nor postmortem macro-evaluation revealed any residual shunts. CONCLUSIONS Beating heart atrial septal defect closure under real-time 3-dimensional echocardiographic guidance is feasible and, unlike catheter-based devices, applicable for any type of secundum atrial septal defect.
Collapse
Affiliation(s)
- Yoshihiro Suematsu
- Department of Cardiac Surgery and Cardiology, Children's Hospital and Harvard Medical School, Boston, Mass 02115, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Advances in robotic technology and imaging systems have enabled the broad application of minimally invasive techniques in cardiac surgery, including coronary artery bypass grafting and mitral valve repair in adults. In pediatric cardiac surgery, however, current robotic systems have been used primarily to facilitate thoracoscopic pediatric procedures on extracardiac lesions, such as ligation of patent ductus and division of vascular rings. The use of smaller instruments with sophisticated robotic wrists may make it possible to perform more complex extracardiac procedures even in young infants. Additionally, future technological improvements, including incorporation of tactile feedback, instrument tracking, and intracardiac imaging (such as real-time 3-dimensional echocardiography), may enable intracardiac robotic surgery to be performed in children. This article reviews the current and potential future applications of pediatric robotic surgery and the developmental work required to enable performance of these procedures, along with an overview of the problems associated with the use of current robotic surgical systems in children.
Collapse
Affiliation(s)
- Yoshihiro Suematsu
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts 02115, USA
| | | |
Collapse
|
21
|
Suematsu Y, Marx GR, Stoll JA, DuPont PE, Cleveland RO, Howe RD, Triedman JK, Mihaljevic T, Mora BN, Savord BJ, Salgo IS, del Nido PJ. Three-dimensional echocardiography–guided beating-heart surgery without cardiopulmonary bypass: A feasibility study. J Thorac Cardiovasc Surg 2004; 128:579-87. [PMID: 15457159 DOI: 10.1016/j.jtcvs.2004.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is no current acceptable approach for intracardiac beating-heart interventions. We have adapted real-time 3-dimensional echocardiography with specialized instrumentation to facilitate beating-heart repair of atrial septal defects and mitral valve plasty to investigate the feasibility of real-time 3-dimensional echocardiography-guided cardiac surgery. METHODS In experiment I a modified real-time 3-dimensional echocardiography system with x4 matrix transducer was compared with 2-dimensional echocardiography in the performance of common surgical tasks. Completion times, deviation from an ideal trajectory, and an echogenic target were measured. In experiment II porcine atrial septal defects were closed with an original semiautomatic suturing device (n = 4) and with a 5-mm endoscopic stapler and a pericardial or polytetrafluoroethylene patch (n = 4). In experiment III a pulsatile porcine mitral valve model was developed, and suture placement through the anterior and posterior mitral leaflets was performed (n = 8). During all experiments, the operator was blinded to the target and operated on only with ultrasonic guidance. RESULTS In experiment I, compared with 2-dimensional echocardiographic guidance, completion times improved by 21% ( P <.01) with high-trajectory accuracy, and suture deviation was significantly smaller (2-dimensional echocardiography, 5.4 +/- 2.7 mm; 3-dimensional echocardiography, 1.7 +/- 0.7 mm; P <.05) in real-time 3-dimensional echocardiography-guided tasks. In experiments II and III in both atrial septal defect closure and mitral valve plasty, real-time 3-dimensional echocardiography provided satisfactory images and sufficient anatomic detail for suturing and patch deployment. All surgical tasks were successfully performed with accuracy. CONCLUSIONS Real-time 3-dimensional echocardiography provides adequate imaging and anatomic detail to act as a sole guide for surgical task performance. These initial experiments demonstrate the feasibility of beating-heart direct or patch closure of atrial septal defects and mitral valve plasty without cardiopulmonary bypass.
Collapse
Affiliation(s)
- Yoshihiro Suematsu
- Department of Cardiac Surgery, Children's Hospital-Boston and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Vasopressin (antidiuretic hormone) is emerging as a potentially major advance in the treatment of a variety of shock states. Increasing interest in the clinical use of vasopressin has resulted from the recognition of its importance in the endogenous response to shock and from advances in understanding of its mechanism of action. From animal models of shock, vasopressin has been shown to produce greater blood flow diversion from non-vital to vital organ beds (particularly the brain) than does adrenaline. Although vasopressin has similar direct actions to the catecholamines, it may uniquely also inhibit some of the pathologic vasodilator processes that occur in shock states. There is current interest in the use of vasopressin in the treatment of shock due to ventricular fibrillation, hypovolaemia, sepsis and cardiopulmonary bypass. This article reviews the physiology and pharmacology of vasopressin and all of the relevant animal and human clinical literature on its use in the treatment of shock following a MEDLINE (1966-2000) search.
Collapse
Affiliation(s)
- P Forrest
- Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
23
|
Warinsirikul W, Sangchote S, Mokarapong P, Chaiyodsilp S, Tanamai S. Closure of atrial septal defects without cardiopulmonary bypass: the sandwich operation. J Thorac Cardiovasc Surg 2001; 121:1122-9. [PMID: 11385379 DOI: 10.1067/mtc.2001.113324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiopulmonary bypass has adverse effects on patient physiology. A prospective randomized trial was undertaken to evaluate closure of atrial septal defects with or without cardiopulmonary bypass. METHODS Between August 1997 and March 2000, 150 patients with ostium secundum atrial septal defects were enrolled. Patients were randomized for repair without cardiopulmonary bypass (ie, the sandwich operation; n = 74) as a study group or with cardiopulmonary bypass (n = 76) as a control group. In the sandwich group the sandwich patch was passed into the right atrium and placed at the defect during transesophageal echocardiography. The patch was secured with external transfixing sutures and endoscopic staples. Clinical outcomes were compared. Outcome variables included perioperative morbidity, mortality, length of stay in the intensive care unit, hospital length of stay from operation to discharge, residual shunt, reoperation, hematologic profile, transfusion requirement, and hospital fee. The follow-up duration ranged from 1 to 29 months (mean, 8.7 +/- 7.5 months). RESULTS There was no operative mortality. The success rate of the sandwich operation was 68 (92%) of 74 patients. Patients in the sandwich group had shorter operative times and lengths of stay in the intensive care unit, fewer requirements of transfusion, and lower hospital fees. The differences in postoperative drainage, arrhythmias, and hematologic profiles could be due to chance. Two patients in the sandwich group required reoperation for residual shunt. The risk factor for residual shunt was earlier date of repair. Mitral and tricuspid valve function was not adversely affected by the operation. CONCLUSIONS Closure of atrial septal defects without cardiopulmonary bypass can be done effectively. Adverse effects of cardiopulmonary bypass can be avoided, as shown by improvements of postoperative parameters with the sandwich operation.
Collapse
Affiliation(s)
- W Warinsirikul
- Institute of Cardiovascular Diseases, Rajavithi Hospital, 2 Rajavithi Road, Bangkok 10400, Thailand.
| | | | | | | | | |
Collapse
|
24
|
Bruggemans EF, Van de Vijver FJ, Huysmans HA. Assessment of cognitive deterioration in individual patients following cardiac surgery: correcting for measurement error and practice effects. J Clin Exp Neuropsychol 1997; 19:543-59. [PMID: 9342689 DOI: 10.1080/01688639708403743] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Assessment of cognitive change in individual patients may be confounded by unreliability of test scores and effects of repeated testing. An index correcting for both problems is proposed and compared with change indices that do not or do not adequately deal with measurement error and practice effects. These indices were used to examine cognitive deterioration in a sample of 63 patients undergoing cardiac surgery. It was demonstrated that for test measures with a low reliability, failure to correct for measurement error resulted in overestimation of deterioration rates. For test measures with a high reliability, but showing substantial practice effects, failure to correct for practice effects resulted in underestimation of deterioration rates. With the proposed index, cognitive deterioration shortly after cardiac surgery was most frequently observed for attention and psychomotor speed, less frequently for verbal fluency, and only occasionally for learning and memory.
Collapse
Affiliation(s)
- E F Bruggemans
- Department of Cardio-Thoracic Surgery, University Hospital, Leiden, The Netherlands
| | | | | |
Collapse
|
25
|
Hofsté WJ, Linssen CA, Boezeman EH, Hengeveld JS, Leusink JA, de-Boer A. Delirium and cognitive disorders after cardiac operations: relationship to pre- and intraoperative quantitative electroencephalogram. INTERNATIONAL JOURNAL OF CLINICAL MONITORING AND COMPUTING 1997; 14:29-36. [PMID: 9127782 DOI: 10.1007/bf03356576] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We examined the incidence of delirium and cognitive disorders after cardiac operations and the related risk factors. The value of pre- and intraoperative QEEG was determined. Using the Mini-Mental State Examination and the Saskatoon Delirium Checklist, 321 patients were tested during the immediate postoperative period. Forty-four patients (14%) showed delirium, 68 (23%) cognitive disorders and 26 (9%) both. Significant risk factors for the development of cognitive disorders were age > or = 70 yr, female gender, duration of cardiopulmonary bypass > or = 2.5 h and aorta-cross-clamping > 70 min. Risk factors for delirium were age > or = 70 yr, female gender and Hb < 5 mmol 1(-1) intraoperatively. The preoperative QEEG showed significant differences between the groups with and without a cognitive disorder, while the intraoperative QEEG showed significant differences between the groups with and without delirium. Different risk factors for delirium and cognitive disorders are a possible explanation for the controversies in the literature, where neuropsychologic complications were grouped together. A low intraoperative Hb is an important risk factor for the development of delirium and can be treated. The preoperative QEEG may have prognostic significance in the occurrence of cognitive disorders, while the intraoperative QEEG may have prognostic significance in the occurrence of delirium.
Collapse
Affiliation(s)
- W J Hofsté
- Department of Anaesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | | | | |
Collapse
|
26
|
Eliasson T, Augustinsson LE, Mannheimer C. Spinal cord stimulation in severe angina pectoris--presentation of current studies, indications and clinical experience. Pain 1996; 65:169-79. [PMID: 8826504 DOI: 10.1016/0304-3959(95)00238-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- T Eliasson
- Department of Medicine, Ostra Hospital, Göteborg, Sweden
| | | | | |
Collapse
|