Robotic Crawler for Epicardial Interventions

描述(由申请人提供)： 由于胸骨正中切开和体外循环相关的并发症，心脏不停跳的内窥镜手术已经成为一个主要的研究目标。心脏跳动的运动给精确的操作带来了很大的问题。此外，现有的大多数微创心脏手术技术都涉及到胸腔镜切开和硬质内窥镜的使用，这使得进入心外膜的某些部分非常困难。 我们假设，对于许多临床程序，心脏跳动和完全心外膜通路的问题可以通过开发一种微型可拆卸机器人设备同时解决，该设备使用吸力附着在心脏上，像尺寸虫一样穿过心脏表面，只通过电线或绳索连接到外部世界，以进行通信和供电。由于该设备可以移动到心外膜表面上的任何所需位置，因此可以使用剑形下视频心包镜方法来代替胸腔镜检查。因此，不需要选择性肺通气。通过避免气管插管，这项技术将允许使用局部或区域麻醉，而不是全身麻醉，为某些程序的门诊心脏手术创造了可能性。 潜在的临床应用有很多；作为一个示范应用，我们建议在心肌注射中展示这项技术，例如用于输送成肌细胞以进行心脏血管重建。具体目标是： 1.研制一种自给式可拆卸的心外膜拴系爬行装置(Heartlander)，它可以通过内窥镜进入心包，附着在不受约束的跳动心脏上，并自行移动，在外科医生指定的任何位置建立适当稳定的工作场所。 2.开发必要的外科末端效应器或工具，使心脏执行器能够准确地进行心肌注射。 3.在拟人心脏跳动模型或假人身上测试这项技术的临床前阶段。 4.在活体动物模型上测试该技术的安全性和性能。

DESCRIPTION (provided by applicant): Endoscopic surgery on the beating heart has become a major research objective due to the morbidity associated with median sternotomy and cardiopulmonary bypass. The motion of the beating heart creates significant problems for ac- curate manipulation. In addition, most existing techniques for minimally invasive cardiac surgery involve the use of thoracoscopic incisions and rigid endoscopes, making access to certain parts of the epicardium highly problematic. We hypothesize that for many clinical procedures the problems of beating heart motion and full epicardial access can be solved simultaneously by developing a miniature detachable robotic device that adheres to the heart using suction and travels like an inchworm across the surface, connected to the outside world only by a wire or tether for communication and power. Because this device can move to any desired point on the epicardial surface, a subxiphoid videopericardioscopic approach can be used instead of thoracoscopy. As a result, selective lung ventilation is not needed. By obviating endotracheal intubation, this technology will allow the use of local or regional rather than general anesthesia, creating the potential for ambulatory outpatient cardiac surgery for certain procedures. Potential clinical applications are numerous; as an exemplary application we propose to demonstrate the technology in myocardial injection, such as is used for delivery of myoblasts for cardiac revascularization. The specific aims are to: 1. Develop a self-contained detachable tethered epicardial crawling device (HeartLander) that can enter the pericardium via endoscope, attach itself to the unconstrained beating heart, and maneuver itself to establish a suitably stable worksite at any location specified by the surgeon. 2. Develop the necessary surgical end-effectors or tools to enable the HeartLander to perform accurate injections into the myocardium. 3. Test the technology preclinical in an anthropomorphic beating-heart phantom or dummy. 4. Test the safety and capability of the technology in vivo in a porcine model.