Robotic Crawler for Epicardial Interventions

在过去的几年里，我们的团队开创了一种创新的微创心脏治疗方法， 不断增长的治疗组合，既吸引微创心脏外科医生， 专家（例如，心脏电生理学家）。该方法包括直接从剑突下进入 心包空间，而不干扰胸壁的完整性和生理。临床程序， 可以从这种方法中受益的包括许多完全或主要在 心包内间隙迄今为止，许多这样的手术是在胸腔镜下进行的， 差异肺通气和气管内全麻。在R 01赠款的最初期间， 我们已经证明了心包内介入跳动的心脏的可行性， 通过开发<$HeartLander <$，一种拴系的微型机器人爬行器，通过 剑突下切口，直接连接到跳动的心脏表面，移动到所需的心外膜 位置，并在外科医生的控制下提供治疗。 近年来心脏医学的一个突出的临床目标是结合诊断的概念 和治疗在一个单一的会议，有时被称为“一站式购物”。HeartLander非常适合作为 用于各种类型的诊断和介入工具的输送工具，因此是用于以下操作的理想工具： 实现这一愿景。潜在的临床应用是众多的;作为示例应用，我们提出 将该技术的发展重点放在与心力衰竭的相关性上。我们假设心脏登陆者 可以自主地标测心外膜梗死区域并进行干预（用注射的墨水描绘该区域） 比训练有素的临床医生使用最先进的手动引导工具更准确和更快速。这 研究旨在开发HeartLander图像引导自主运动的方法，首先使用静态 心脏图像数据，然后使用动态（跳动）心脏图像。图像引导自主导航技术 将开发心外膜标测。最后，将开发用于同时图像引导的方法， 自主心脏标测和介入。所有开发的技术都将得到评估， 首先在适当的人工心脏模型中，然后在猪体内模型中。

In the last few years our group has pioneered an innovative minimally invasive approach to the heart for a growing portfolio of therapies that appeals to both minimally invasive cardiac surgeons and interventional specialists (e.g., cardiac electrophysiologists). The approach involves direct subxiphoid access to the pericardial space without interfering with the chest wall integrity and physiology. The clinical procedures that could benefit from such an approach include many that are performed wholly or primarily within the intrapericardial space. To date, many such procedures are performed thoracoscopically, necessitating differential lung ventilation and general endotracheal anesthesia. During the original period of this R01 grant, we have demonstrated the feasibility of intrapericardial intervention on the beating heart without entering the pleural space by developing ¿HeartLander¿, a tethered miniature robotic crawler that enters the pericardium via subxiphoid incision, attaches itself directly to the surface of the beating heart, moves to the desired epicardial location, and delivers therapy under the control of the surgeon. A prominent clinical goal in recent years in cardiac medicine has been the concept of combining diagnosis and treatment in a single session, sometimes referred to as ¿one-stop shopping.¿ HeartLander is well suited as a delivery vehicle for both diagnostic and interventional tools of various types, and as such is an ideal tool for realizing this vision. Potential clinical applications are numerous; as an example application we propose to focus the development of the technology on its relevance to heart failure. We hypothesize that HeartLander can autonomously map an infarct region epicardially and intervene (delineating the region with injected ink) more accurately and more rapidly than a trained clinician using state-of-the-art hand-guided tools. This research aims to develop methods for image-guided autonomous locomotion of HeartLander, first using static heart image data, and then using dynamic (beating) heart imagery. Techniques for image-guided autonomous epicardial mapping will be developed. Finally, methods will be developed for simultaneous image-guided autonomous cardiac mapping and intervention in a single session. All techniques developed will be evaluated, first in appropriate artificial heart phantoms, and then in a porcine model in vivo.