“Totally endoscopic robotic atrial septal defect repair on the beating heart.”
Gao, C., M. Yang, et al. (2010).
Heart Surgery Forum 13(3).
Background: Atrial septal defect (ASD) repairs have successfully been performed on the arrested heart with the da Vinci S Surgical System (Intuitive Surgical). This study assessed the feasibility, safety, and efficacy of the use of the da Vinci S Surgical System for on-pump ASD repairs on the beating heart without cross-clamping the aorta. Methods: This prospective study included 24 consecutive patients who underwent ASD repair surgery between June 2008 and June 2009. All of the procedures were completed with the da Vinci S robot via 3 port incisions in the right chest and a 1.5-cm working port. The operations were carried out on the beating heart with mild hypothermic cardiopulmonary bypass (CPB) without cross-clamping the aorta. Venting the heart from the working port provided adequate visualization of the operative field. Results: All patients underwent complete repairs. Fourteen patients underwent ASD closure with a fresh autogenous pericardial patch, and 10 patients underwent direct ASD closure. Concomitant surgery was required in 4 patients. The mean (±SEM) CPB time was 65.6 ± 17.7 minutes, and the mean operative time was 98.5 ± 19.3 minutes. No patient required transfusion of red blood cells. The length of patient stay in the intensive care unit was 0.5 to 1.0 days. The length of hospital stay was 4 to 5 days. Follow-up transthoracic echocardiography evaluations showed no residual atrial septal leakage. There were no operative deaths, strokes, or other complications. All of the patients were discharged. Conclusions: We have shown that use of the da Vinci S Surgical System to perform on-pump ASD repairs on the beating heart without cross-clamping the aorta is feasible, safe, and effective. © 2010 Forum Multimedia Publishing, LLC.
“Optimal transseptal puncture location for robot-assisted left atrial catheter ablation.”
Jayender, J., R. V. Patel, et al. (2009).
Medical image computing and computer-assisted intervention : MICCAI … International Conference on Medical Image Computing and Computer-Assisted Intervention 12(Pt 1): 1-8.
The preferred method of treatment for Atrial Fibrillation (AF) is by catheter ablation wherein a catheter is guided into the left atrium through a transseptal puncture. However, the transseptal puncture constrains the catheter, thereby limiting its maneuverability and increasing the difficulty in reaching various locations in the left atrium. In this paper, we address the problem of choosing the optimal transseptal puncture location for performing cardiac ablation to obtain maximum maneuverability of the catheter. We have employed an optimization algorithm to maximize the Global Isotropy Index (GII) to evaluate the optimal transseptal puncture location. As part of this algorithm, a novel kinematic model for the catheter has been developed based on a continuum robot model. Preoperative MR/CT images of the heart are segmented using the open source image-guided therapy software, Slicer 3, to obtain models of the left atrium and septal wall. These models are input to the optimization algorithm to evaluate the optimal transseptal puncture location. Simulation results for the optimization algorithm are presented in this paper.
“A cost-analysis study of robotic versus conventional mitral valve repair.”
Kam, J. K., S. D. Cooray, et al. (2010).
Heart Lung and Circulation 19(7): 413-418.
Background: Robotic mitral valve repair has been performed in Australia since 2004. The aim of this study was to perform a cost-analysis of robotic mitral valve repair (MVR) with direct comparison to conventional MVR surgery. Methods: All isolated MVRs performed within one metropolitan hospital network, between June 2005 and June 2008, were retrospectively compared. Ad hoc cost analysis was conducted. Results: There were 107 robotic and 40 conventional MVRs performed. The post-operative degrees of mitral regurgitation were comparable. Total operating time was 18% longer in robotic compared to conventional (239. min vs. 202. min, p< 0.001, 95% CI: 11-27%). In robotic, Intensive Care Unit stay was reduced by 19% (p= 0.002, 37. h vs. 45. h), and length of hospital stay was reduced by 26% (p< 0.001, 6.47 days vs. 8.76 days). Mean hospital cost, without including capital costs, was not significantly increased (AUD$18,503 vs. AUD$17,880 p= 0.176, 95% CI: -282 to 1,530). Conclusions: Robotic mitral repair can be performed with similar immediate repair success rates as conventional surgery with a shorter recovery time, but a slightly longer operative time. There is no significant increase in cost over conventional surgery. © 2010.
“Robotically assisted atraumatic coronary artery bypass: a feasible option for off-pump coronary surgery.”
Khoshbin, E., S. Martin, et al. (2010).
Journal of Robotic Surgery: 1-6.
This retrospective study of the largest single center experience (100 patients) with off-pump robotically assisted coronary procedures in the United Kingdom (April 2002-June 2008) aimed to rationalize patient selection, describe the technique, and determine the learning curve, technical feasibility and operative outcome of robotically assisted Atraumatic Coronary Artery Bypass (ACAB). Selected patients underwent either a robotic Totally Endoscopic Coronary Artery Bypass (12) or robotically assisted ACAB (88) using a standard Da Vinci robot with three arms. A fifth of all cases had percutaneous interventions as part of a hybrid strategy. The majority of patients were overweight men. After one hundred robotic coronary procedures, this operation is now performed as part of a routine theatre list. The mean operative and total procedure times for robotically assisted atraumatic procedures were 157 and 238 min, respectively. These measurements were significantly less in the atraumatic than the totally endoscopic group with a 34.3 and 20.6% reduction, respectively (P < 0.001; equal variance not assumed). The procedural learning curve was short and independent from internal thoracic artery harvesting. We have proven conclusively that robotically assisted ACAB is feasible, more so than the totally endoscopic procedure in this particular setting. Even in the absence of an ideal stabilizer device, this procedure causes minimal disruption to the daily operating room schedule. We have also proven that body mass index is a weak predictor of the ease of robotic internal thoracic artery harvesting and should not affect patient selection. © 2010 Springer-Verlag London Ltd.
“Robotic force stabilization for beating heart intracardiac surgery.”
Yuen, S. G., M. C. Yip, et al. (2009).
Medical image computing and computer-assisted intervention : MICCAI … International Conference on Medical Image Computing and Computer-Assisted Intervention 12(Pt 1): 26-33.
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.