Robotic Crawler for Epicardial Interventions

描述(申请人提供)：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，用于越来越多的治疗组合，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)。该入路涉及剑突下直接进入心包腔，而不影响胸壁的完整性和生理。可以从这种入路获益的临床手术包括许多完全或主要在心包腔内进行的手术。到目前为止，许多这样的手术都是在胸腔镜下进行的，需要区别肺通气和全身气管内麻醉。在这份R01拨款的最初阶段，我们已经展示了在不进入胸膜空间的情况下对心包内心脏进行干预的可行性，开发了一种可系绳的微型机器人爬行器，它通过剑突下切开进入心包，直接附着到心脏跳动的表面，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在一个疗程中结合诊断和治疗的概念，有时被称为“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输送工具，因此是实现这一愿景的理想工具。潜在的临床应用有很多；作为一个例子，我们建议将这项技术的开发重点放在它与心力衰竭的相关性上。我们假设，与训练有素的临床医生使用最先进的手动工具相比，哈特兰德可以自动绘制心外膜梗死区的地图，并更准确、更快速地干预(用注射墨水描绘区域)。这项研究旨在开发图像引导的心脏自主运动方法，首先使用静态心脏图像数据，然后使用动态(跳动)心脏图像。将开发图像引导的自主心外膜标测技术。最后，将开发在一次会议中同时进行图像引导的自主心脏标测和干预的方法。所有开发的技术都将进行评估，首先是在合适的人工心脏模型中，然后是在活体的猪模型中。

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.