Robot Assisted Cardiac Surgery

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Robot Assisted Cardiac Surgery

• Course Cardiovascular Imaging
• Submitted by Alper Yaman
• Instructor Assoc. Prof. Dr. Cengizhan Öztürk

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What is robot assisted surgery?

• Application of computer assisted robotics to
  enhance surgeons capability to carry out various
  minimally invasive surgical procedures.

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The advantages of robotic surgery

• Faster, easier and steadier surgery
• More accuracy
• Enhanced visualisation, zooming
• Minimally invasive 1.

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The advantages of robotic surgery 2

• Less pain to patient
• Shorter recovery time
• Shorter hospital stays 1

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Robot Assisted Surgery Approach
Perception imaging by sensors and cameras
to monitor the heart
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Robot Assisted Surgery Approach 2
Arms and wrists for clamping, suturing, and
severing.
Control Panel
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Technical Information

• Registration Preoperative images (CT or MRI) are
  registered both to stabilize target point images
  on the monitor and to guide the manipulators 2.
• Imaging
• Fast video cameras are used to obtain operative
  images.

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Technical Information 2

• Robot Positioning
• Optimal position of the robot should be provided
  concerning with degrees of freedom of the
  manipulator 2.

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Technical Information 3

• Port Placement Entry points are selected by
  images on the port.
• Robot is registered to the patient.
• Ports are expressed in the robot coordinate frame
  and used to guide the surgeon 2.

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Heart Beat SynchronizationMotion Cancelling
Robot System

• Visual Synchronization Provides stabilized
  target point images on the monitor.
• Motion Synchronization The slave robot is
  synchronized with the heart beat.
• Master Slave Control Transfers the master
  motion to control the slave robot 3.

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Heart Beat Synchronization Motion Cancelling
Robot System
3
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Haptics and Augmented Reality

• Haptics
• Applying tactile sensation and control to
  interaction with computer applications.
• Augmented Reality
• Computer graphics are superimposed or composited
  with real images.

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Haptic Virtual Fixtures

• Software-generated force and position signals
  applied to human operators.
• To improve the safety, accuracy, and speed of
  manipulation tasks.
• Integrates robots accuracy and precision with
  human intelligence 4.

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Haptic Virtual Fixtures 2

• Guidance Virtual Fixtures guides the robot along
  desired paths (a).
• Forbidden-Region Virtual Fixtures Keep the robot
  out of forbidden regions (b). 4

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An example to robotsDa Vinci Surgical System

• Intuitive nature of the surgeons hand movements
• Components
• A surgeon console
• Patient-side cart
• Instruments
• Image processing equipment

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An example to robotsDa Vinci Surgical System 2

• Benefits For The Surgeon
• Improved dexterity
• Enhanced 3D visualisation and magnification
• Greater surgical precision
• Increased range of motion
• Better ergonomics

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An example to robotsDa Vinci Surgical System 3
Robotic articulated instrumentation daVinci
prototype 1997 5
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An example to robots
Leipzig 1998 5
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Current Operations with daVinci

• Atrial septal defect closure
• Internal thoracic artery take-down
• Endoscopic coronary bypass
• LV bipolar pacing lead placement
• Mitral valve repairment and replacement
• Ablation of atrial fibrillation 5

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Current Operations with daVinci 2
5
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Current Operations with daVinci 3
5
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Transmyocardial Revascularization

• Laser is used to open tiny holes (transmyocardial
  channels) on myocardium.
• Angiogenesis Laser stimulates new blood vessels
  to grow.
• Channels heal on the outside but remain open on
  the inside. 6

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Transmyocardial Revascularization 2
6
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Results and Discussion

• Robot assisted cardiac surgery is combining
  various disciplines robotics, computer vision
  and biomedical engineering. Its advantages are
• Faster, easier and steadier surgery
• More accuracy
• Enhanced visualisation, zooming
• Minimally invasive
• Less pain to patient
• Shorter recovery time
• Shorter hospital stays

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References

1. E. Adams, Bibliography Robotic Surgery,
   Technology Assessment Program, Office of Patient
   Care Services, Boston, March 2004.
2. E. Coste-Maniere and L. Adhami. Optimal
   Planning of Robotically Assisted Heart Surgery
   Transfer Precision in the Operating Room. The
   International Journal of Robotics Research, Vol.
   23, No. 4-5, 539-548 (2004).
3. Y. Nakamura, K. Kishi, and H. Kawakami. Heartbeat
   Synchronization for Robotic Cardiac Surgery.
   Proc. of the IEEE. International Conf. On
   RoboticsAutomation, pp. 2014-2019, 2001.
4. J. J. Abbott, P. Marayong, and A. M. Okamura,
   "Haptic Virtual Fixtures for Robot-Assisted
   Manipulation," 12th International Symposium of
   Robotics Research, 2005. (accepted).
5. W. R. Chitwood. Robotic Cardiac Surgery. 90th
   Annual Clinical Congress , American College of
   Surgeons, New Orleans, 2004.
6. Cleveland Clinic Heart Center web page,
   http//www.clevelandclinic.org/heartcenter/pub/gui
   de/disease/cad/TMR.htm

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Thank you

• for your attention!