scholarly journals Cardiac patch transplantation instruments for robotic minimally invasive cardiac surgery: initial proof-of-concept designs and surgery in a porcine cadaver [preprint]

2021 ◽  
Author(s):  
Christopher David Roche ◽  
Gautam R Iyer ◽  
Minh H Nguyen ◽  
Sohaima Mabroora ◽  
Anthony Dome ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Control Systems ◽  
Open Surgery ◽  
Heart Surgery ◽  
Simulation Software ◽  
Surgical Instruments ◽  
Proof Of Concept ◽  
Surgical Operation ◽  
Cardiac Tissues

BACKGROUND: Damaged cardiac tissues could potentially be regenerated by transplanting bioengineered cardiac patches to the heart surface. To be fully paradigm-shifting, such patches may need to be transplanted using minimally invasive robotic cardiac surgery (not only traditional open surgery). Here, we present novel robotic designs, initial prototyping and a new surgical operation for instruments to transplant patches via robotic minimally invasive heart surgery. METHODS: Robotic surgical instruments and automated control systems were designed, tested with simulation software and prototyped. Surgical proof-of-concept testing was performed on a pig cadaver. RESULTS: Three robotic instrument designs were developed. The first (called “Claw” for the claw-like patch holder at the tip) operates on a rack and pinion mechanism. The second design (“Shell-Beak”) uses adjustable folding plates and rods with a bevel gear mechanism. The third (“HeartStamp”) utilises a stamp platform protruding through an adjustable ring. For the HeartStamp, rods run through a cylindrical structure designed to fit a uniportal Video-Assisted Thorascopic Surgery (VATS) surgical port. Designed to work with or without a sterile sheath, the patch is pushed out by the stamp platform as it protrudes. Two instrument robotic control systems were designed, simulated in silico and one of these underwent early ‘sizing and learning’ prototyping as a proof-of-concept. To reflect real surgical conditions, surgery was run “live” and reported exactly (as-it-happened). We successfully picked up, transferred and released a patch onto the heart using the HeartStamp in a pig cadaver model. CONCLUSION: These world-first designs, early prototypes and a novel surgical operation pave the way for robotic instruments for automated keyhole patch transplantation to the heart. Our novel approach is presented for others to build upon free from restrictions or cost – potentially a significant moment in myocardial regeneration surgery which may open a therapeutic avenue for patients unfit for traditional open surgery.

scholarly journals Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Terézia B. Andrási ◽  
Nunijiati Abudureheman ◽  
Alannah Glück ◽  
Maximilian Vondran ◽  
Gerhard Dinges ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Surgical Instruments ◽  
Tricuspid Valve Repair ◽  
Long Term Outcome ◽  
Tricuspid Valve Insufficiency ◽  
Valve Insufficiency ◽  
Neurosurgical Intervention

Abstract Background The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. Case presentation A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. Conclusion The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.

The Swan-Ganz Catheter as a Teaching Tool for the Anesthesiologist Learning Minimally Invasive Cardiac Surgery

2012 ◽  
Vol 7 (3) ◽  
pp. 204-207
Author(s):  
Enrique J. Pantin ◽  
Jonathan L. Kraidin ◽  
Steven H. Ginsberg ◽  
John T. Denny ◽  
Mark B. Anderson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Transesophageal Echocardiography ◽  
Coronary Sinus ◽  
Management Strategy ◽  
Heart Surgery ◽  
Operative Management ◽  
Minimally Invasive Cardiac Surgery ◽  
Training Tool ◽  
Coronary Sinus Catheter

Objective To perform minimally invasive cardiac surgery through the smallest possible wound and with the least number of incisions in the heart or aorta, the necessary cannulations to undergo cardiopulmonary bypass must be done through peripheral vessels. A difficult skill to learn for the cardiac anesthesiologist is how to safely and efficiently position the coronary sinus catheter (Endoplege; Edwards Lifesciences LLC, Irvine, CA USA) required for retrograde cardioplegia administration. Methods In patients in whom a Swan-Ganz catheter was inserted as part of the operative management strategy for non–minimally invasive heart surgery, we have been using it as a training tool to learn how to visualize and manipulate right-sided catheters under transesophageal echocardiography. We developed this teaching technique to help hone some of the necessary skills needed to place the Endoplege catheter for minimally invasive cardiac surgery. Manipulation was done with the goal of visualizing the catheter and guiding it into the coronary sinus. For a 4-month period, anesthesia records were retrospectively reviewed. Results Fifteen patients, for a total of 19 catheter manipulations, were found in whom we had documented the use of the Swan-Ganz catheter and details about the insertion as a training tool. The coronary sinus and the catheter were visualized 100% of the time. The Swan-Ganz catheter was successfully inserted into the coronary sinus in 17 of 19 catheter manipulations. Conclusions The Swan-Ganz catheter can be used as a training tool to develop some of the necessary skills to place catheters into the coronary sinus with transesophageal echocardiography guidance.

scholarly journals Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

2021 ◽  
Author(s):  
Terezia B. Andrasi ◽  
Nunijiati Abudureheman ◽  
Alannah Glück ◽  
Maximillian Vondran ◽  
Ildar Talipov ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Surgical Instruments ◽  
Tricuspid Valve Repair ◽  
Long Term Outcome ◽  
Tricuspid Valve Insufficiency ◽  
Valve Insufficiency ◽  
Neurosurgical Intervention

Abstract Background: The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. Case Presentation: A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery. Conclusion: The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.

scholarly journals Haptic Feedback in a Telepresence System for Endoscopic Heart Surgery

2007 ◽  
Vol 16 (5) ◽  
pp. 459-470 ◽  
Author(s):  
Hermann Mayer ◽  
Istvan Nagy ◽  
Alois Knoll ◽  
Eva U Braun ◽  
Robert Bauernschmitt ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Heart Surgery ◽  
Force Feedback ◽  
Haptic Feedback ◽  
Suture Material ◽  
Autonomous Robot ◽  
Surgical Instruments ◽  
Sensory Substitution ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures

The implementation of telemanipulator systems for cardiac surgery enabled heart surgeons to perform delicate minimally invasive procedures with high precision under stereoscopic view. At present, commercially available systems do not provide force-feedback or Cartesian control for the operating surgeon. The lack of haptic feedback may cause damage to tissue and can cause breaks of suture material. In addition, minimally invasive procedures are very tiring for the surgeon due to the need for visual compensation for the missing force feedback. While a lack of Cartesian control of the end effectors is acceptable for surgeons (because every movement is visually supervised), it prevents research on partial automation. In order to improve this situation, we have built an experimental telemanipulator for endoscopic surgery that provides both force-feedback (in order to improve the feeling of immersion) and Cartesian control as a prerequisite for automation. In this article, we focus on the inclusion of force feedback and its evaluation. We completed our first bimanual system in early 2003 (EndoPAR Endoscopic Partial Autonomous Robot). Each robot arm consists of a standard robot and a surgical instrument, hence providing eight DOF that enable free manipulation via trocar kinematics. Based on the experience with this system, we introduced an improved version in early 2005. The new ARAMIS system (Autonomous Robot Assisted Minimally Invasive Surgery) has four multi-purpose robotic arms mounted on a gantry above the working space. Again, the arms are controlled by two force-feedback devices, and 3D vision is provided. In addition, all surgical instruments have been equipped with strain gauge force sensors that can measure forces along all translational directions of the instrument's shaft. Force-feedback of this system was evaluated in a scenario of robotic heart surgery, which offers an impression very similar to the standard, open procedures with high immersion. It enables the surgeon to palpate arteriosclerosis, to tie surgical knots with real suture material, and to feel the rupture of suture material. Therefore, the hypothesis that haptic feedback in the form of sensory substitution facilitates performance of surgical tasks was evaluated on the experimental platform described in the article (on the EndoPAR version). In addition, a further hypothesis was explored: The high fatigue of surgeons during and after robotic operations may be caused by visual compensation due to the lack of force-feedback (Thompson, J., Ottensmeier, M., & Sheridan, T. 1999. Human Factors in Telesurgery, Telmed Journal, 5 (2) 129–137.).

scholarly journals Remote Minimally Invasive Surgery – Haptic Feedback and Selective Automation in Medical Robotics

2011 ◽  
Vol 8 (2) ◽  
pp. 221-236 ◽  
Author(s):  
Christoph Staub ◽  
Keita Ono ◽  
Hermann Mayer ◽  
Alois Knoll ◽  
Heinz Ulbrich ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Heart Surgery ◽  
Force Feedback ◽  
Haptic Feedback ◽  
Medical Robotics ◽  
Contact Forces ◽  
Working Environment ◽  
Surgical Instruments ◽  
Prediction Algorithm ◽  
Robot System

The automation of recurrent tasks and force feedback are complex problems in medical robotics. We present a novel approach that extends human-machine skill-transfer by a scaffolding framework. It assumes a consolidated working environment for both, the trainee and the trainer. The trainer provides hints and cues in a basic structure which is already understood by the learner. In this work, the scaffolding is constituted by abstract patterns, which facilitate the structuring and segmentation of information during “Learning by Demonstration” (LbD). With this concept, the concrete example of knot-tying for suturing is exemplified and evaluated. During the evaluation, most problems and failures arose due to intrinsic system imprecisions of the medical robot system. These inaccuracies were then improved by the visual guidance of the surgical instruments. While the benefits of force feedback in telesurgery has already been demonstrated and measured forces are also used during task learning, the transmission of signals between the operator console and the robot system over long-distances or across-network remote connections is still a challenge due to time-delay. Especially during incision processes with a scalpel into tissue, a delayed force feedback yields to an unpredictable force perception at the operator-side and can harm the tissue which the robot is interacting with. We propose a XFEM-based incision force prediction algorithm that simulates the incision contact-forces in real-time and compensates the delayed force sensor readings. A realistic 4-arm system for minimally invasive robotic heart surgery is used as a platform for the research.

Borrowing from Adult Cardiac Surgeons—Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era

2020 ◽  
Vol 15 (2) ◽  
pp. 101-105
Author(s):  
Mohammed K. Alsarraj ◽  
Joseph R. Nellis ◽  
Andrew M. Vekstein ◽  
Nicholas D. Andersen ◽  
Joseph W. Turek
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Heart Surgery ◽  
Median Sternotomy ◽  
Case Series ◽  
Standard Of Care ◽  
Congenital Heart Surgery ◽  
Respiratory Dysfunction ◽  
Cardiac Surgeons ◽  
Adult Cardiac Surgery

The majority of congenital and adult cardiac surgery is performed through a median sternotomy. For surgeons, this incision provides excellent exposure; however, for patients, a median sternotomy confers a poorer cosmetic outcome and the possibility of postoperative respiratory dysfunction, chronic pain, and deep sternal wound infections. Despite the advances in adult cardiac surgery, the use of minimally invasive techniques in pediatric patients is largely limited to small case series and less complex repairs. In this article, we review the risks, benefits, and limitations of the minimally invasive congenital cardiac approaches being performed today. The interest in these approaches continues to grow as more data supporting reduced morbidity, decreased length of stay, and faster recovery are published. In the future, as the technology and surgical familiarity improve, these alternative approaches will become more common, and may someday become the standard of care.

Minimally Invasive Cardiac Surgery in the Adult: Surgical Instruments, Equipment, and Techniques

1998 ◽  
Vol 22 (9) ◽  
pp. 765-768 ◽  
Author(s):  
Masaya Kitamura ◽  
Kazuhiko Uwabe ◽  
Jun Hirota ◽  
Akihiko Kawai ◽  
Masahiro Endo ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Minimally Invasive Cardiac Surgery ◽  
Surgical Instruments

scholarly journals Minimally Invasive Cardiac Surgery

2013 ◽  
Vol 1 (3) ◽  
pp. 62-66
Author(s):  
RS Dhaliwal
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Heart Surgery ◽  
Low Cost ◽  
Open Heart Surgery ◽  
Left Ventricular ◽  
Minimally Invasive Cardiac Surgery ◽  
Patient Comfort ◽  
Routine Activity ◽  
Therapeutic Modality

Conventional open heart surgery on cardiopulmonary bypass although safe and effective, but is associated with definite morbidity and mortality due to deleterious effects on body systems like haematological, renal, hepatic, respiratory and nervous system. In the last two decades minimally invasive cardiac surgery is rapidly emerging as a safe and cost effective alternative therapeutic modality. The aims of minimally invasive cardiac  surgery are to  achieve an  early extubation, less blood loss, rapid recovery, shorter  hospital stay, less patient morbidity, faster return to  routine activity, increased patient comfort and low cost without compromising on the results. Various strategies have been developed to avoid cardio-pulmonary bypass, global myocardial ischemia and hypothermia. Minimally invasive cardiac surgery is especially beneficial in patients who are at high risk due to left ventricular dysfunction, calcified aorta, carotid artery occlusion, bleeding diathesis and impaired renal dysfunctionDOI: http://dx.doi.org/10.3126/jucms.v1i3.8769Journal of Universal College of Medical Sciences Vol.1(3) 2013: 62-66

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