Articulated Robot for Epicardial Interventions

用于心外膜介入治疗的铰接式机器人

• 批准号: 7433720
• 负责人: MARCO A. ZENATI
• 金额: $ 32.76万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7433720
• 关键词: Ablation; Address; Adoption; Animals; Atrial Fibrillation; Bronchoscopy; Cadaver; Cardiac; Cardiac Surgery procedures; Cell Transplantation; Colonoscopy; Development; Devices; Electronics; Epicardium; Family suidae; Goals; Heart; Human; Injection of therapeutic agent; Intervention; Invasive; Laparoscopy; Lead; Left; Ligation; Location; Motion; Operative Surgical Procedures; Organ; Pericardial cavity; Physicians; Placement; Procedures; Risk; Robot; Robotics; Self-Help Devices; Stroke; Sum; Surgeon; System; Technology; Testing; Therapeutic; Therapeutic Intervention; Validation; Vision; auricular appendage; base; clinically relevant; concept; design; frontier; hemodynamics; in vivo Model; innovation; kinematics; pericardial sac; prototype; radius bone structure; tool

DESCRIPTION (provided by applicant): In order to overcome the limitations of currently available assistive technologies for minimally invasive cardiac surgery (MICS), we propose to develop and test an innovative approach based on a highly articulated robotic probe (HARP). We believe that, for procedures involving epicardial interventions on the beating heart, MICS can be effectively realized with the HARP, entering the pericardial cavity through a subxiphoid port, reaching remote intrapericardial locations on the epicardium without causing hemodynamic and electrophysiologic interference and delivering therapeutic interventions under the direct control of the surgeon. The main goal of the HARP is to extend the sensing and manipulation ability of the physician by taking advantage of the high maneuverability of the HARP to steer around organs and reach anatomical landmarks which are not accessible to the conventional rigid and flexible endoscopic tools. We chose minimally cardiac surgery as a focus domain or, more specifically, subxiphoid videopericardioscopy as our target application because it represents all of the challenges that most procedures would have and has significant merit on its own. As an exemplary application that, in our opinion, sums most of the challenges that can be encountered with a broad array of epicardial interventions on the beating heart, we hereby propose to test the use of the HARP for the ligation of the left atrial appendage (LAA), a clinically relevant approach to reduce the risk of stroke in atrial fibrillation. We strongly believe that addressing this exemplary application represents a challenge that will enhance HARP's functionality and will eventually lead to expansion of its application to multiple intrapericardial therapies (e.g. cell transplantation by intramyocardial injection, epicardial ablation, epicardial lead placement for resynchronization, etc). With respect to this clinically relevant application, we hypothesize that the HARP will achieve superior results when compared with the existing rigid subxiphoid videopericardioscopy technology for intrapericardial navigation, which in turn will allow for ligation of LAA.The specific aims are designed to further develop the existing 12mm HARP prototype, and then to test it and comparing it to the existing subxiphoid videopericardioscopy device in an anthropomorphic phantom, in animals and human cadavers. Our broad, long-term objective is to fulfill our group's "epicardial frontier" vision, enabling a growing portfolio of epicardial therapies by developing and testing new dedicated innovative robotic technology. We envision the adoption of HARP-based intrapericardial therapies not only by minimally invasive cardiac surgeons, but also by interventional cardiologists and electrophysiologists. We also believe that the HARP may expand the therapeutic options for other non-cardiac endoscopic applications .

描述（由申请人提供）：为了克服微创心脏手术（MICS）当前可用辅助技术的局限性，我们建议开发和测试一种基于高度铰接机器人探头（HARP）的创新方法。我们认为，对于涉及跳动心脏上心外膜介入的手术，MICS可以通过HARP有效实现，通过剑突下端口进入心包腔，到达心外膜上的远端心包内位置，而不会引起血流动力学和电生理学干扰，并在外科医生的直接控制下进行治疗介入。HARP的主要目标是通过利用HARP的高机动性来扩展医生的感知和操纵能力，以绕过器官并到达传统刚性和柔性内窥镜工具无法触及的解剖标志。我们选择微创心脏手术作为重点领域，或者更具体地说，剑突下视频心包镜检查作为我们的目标应用，因为它代表了大多数手术所面临的所有挑战，并且本身具有显著的优点。作为一个示例性应用，在我们看来，总结了在跳动的心脏上广泛的心外膜介入可能遇到的大多数挑战，我们在此提出测试HARP用于左心耳（LAA）结扎的使用，这是一种降低房颤中风风险的临床相关方法。我们坚信，解决该示例性应用代表了一个挑战，该挑战将增强HARP的功能，并将最终导致其应用扩展到多种心包内治疗（例如，通过心肌内注射的细胞移植、心外膜消融、心外膜引线放置以用于钙化等）。关于该临床相关应用，我们假设HARP与用于心包内导航的现有刚性剑突下视频心包镜技术相比将获得上级结果，后者反过来将允许LAA结扎。具体目的旨在进一步开发现有12 mm HARP原型，然后在动物和人类尸体上测试它并将其与现有的剑突下视频心包镜装置进行比较。 我们广泛的长期目标是实现我们集团的“心外膜前沿”愿景，通过开发和测试新的专用创新机器人技术，实现不断增长的心外膜治疗产品组合。我们设想采用基于HARP的心包内治疗，不仅微创心脏外科医生，而且介入心脏病学家和电生理学家。我们还认为，HARP可能会扩大其他非心脏内镜应用的治疗选择。