Robotic Crawler for Epicardial Interventions

用于心外膜介入治疗的机器人爬行器

• 批准号: 8274731
• 负责人: Cameron N Riviere
• 金额: $ 36.95万
• 依托单位: CARNEGIE-MELLON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8274731
• 关键词: Anesthesia procedures; Area; Artificial Heart; Cardiac; Chest wall structure; Clinical; Data; Data Set; Diagnosis; Diagnostic; Electrocardiogram; Electrodes; Environmental air flow; Epicardium; Evaluation; Family suidae; Goals; Grant; Hand; Health; Heart; Heart failure; Image; Imagery; Imaging Techniques; In Vitro; Infarction; Injection of therapeutic agent; Ink; Intervention; Investigation; Joystick; Location; Locomotion; Lung; Magnetism; Maps; Medicine; Methods; Modeling; Motor; Outcome; Pericardial body location; Physiology; Pleural; Positioning Attribute; Procedures; Process; Public Health; Reading; Research; Robotics; Running; Simulate; Specialist; Suction; Surface; Surgeon; Surgical incisions; System; Techniques; Technology; Testing; Tissues; Training; Vision; clinical application; design; electric impedance; endotracheal; epicardial mapping; heart imaging; imaging modality; improved; in vivo; in vivo Model; innovation; minimally invasive; pericardial sac; prototype; technology development; tissue phantom; tool

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: This research aims to develop technology that will improve public health outcomes by enhancing the capabilities of surgeons and cardiologists to access and treat the surface of the beating heart through small incisions, without requiring deflation of a lung for access.

描述（由申请人提供）：在过去的几年中，我们的团队开创了一种创新的心脏微创方法，用于不断增长的治疗组合，吸引了微创心脏外科医生和介入专家（例如心脏电生理学家）。该方法包括直接从剑突下进入心包间隙，而不干扰胸壁的完整性和生理机能。可以从这种方法中受益的临床手术包括许多完全或主要在心包内空间内进行的手术。迄今为止，许多此类手术都是通过胸腔镜进行的，需要差压肺通气和全身气管内麻醉。在本次 R01 资助的最初阶段，我们通过开发“HeartLander”展示了在不进入胸膜腔的情况下对跳动的心脏进行心包内干预的可行性。“HeartLander”是一种系留的微型机器人爬行器，通过剑突下切口进入心包，将自身直接附着在跳动的心脏表面，移动到所需的心外膜位置，并在外科医生的控制下进行治疗。近年来，心脏医学的一个突出临床目标是在一次会议中将诊断和治疗结合起来的概念，有时称为“一站式购物”。 HeartLander 非常适合作为各种类型的诊断和介入工具的交付工具，因此是实现这一愿景的理想工具。潜在的临床应用有很多；作为一个示例应用，我们建议将该技术的开发重点放在其与心力衰竭的相关性上。我们假设 HeartLander 可以自动绘制心外膜梗塞区域图，并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、更快速地进行干预（用注射墨水描绘该区域）。本研究旨在开发 HeartLander 的图像引导自主运动方法，首先使用静态心脏图像数据，然后使用动态（跳动）心脏图像。将开发图像引导自主心外膜测绘技术。最后，将开发在单次会议中同时进行图像引导自主心脏测绘和干预的方法。所有开发的技术都将首先在适当的人造心脏模型中进行评估，然后在猪体内模型中进行评估。公共健康相关性：这项研究旨在开发技术，通过增强外科医生和心脏病专家通过小切口接触和治疗跳动心脏表面的能力，从而改善公共健康结果，而无需对肺部进行放气。