Development of Robotic Tools for Totally Endoscopic Off-Pump Coronary Artery Bypa

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DESCRIPTION (provided by applicant): The long term objective of the proposed research study is to develop and validate a robotic telesurgical system for performing totally endoscopic off-pump coronary artery bypass graft (CABG) surgery without passive stabilization. As a technology-driven translational research project motivated by an important clinical need, the research in the present study will specifically focus on development of sensor systems for in-vivo measurement of heart motion, and in vivo validation of the developed technologies for motion tracking, and arrhythmia handling. CABG surgery, a very effective technique for coronary revascularization to treat coronary artery disease, is the most common major surgery performed in the United States. Traditional CABG is performed as an open chest procedure by making a cut down the sternum (chest bone) to access the heart. During the traditional CABG surgery, the heart is stopped, and a cardiopulmonary bypass machine is used to oxygenate the blood and maintain blood circulation in the body. Off-pump CABG surgery is an alternative technique where the surgery is performed while the heart is still beating, instead of using a cardiopulmonary bypass machine and stopping the heart. Endoscopic CABG surgery is a minimally invasive technique for performing CABG surgery using instruments inserted through small incisions, instead of opening the sternum. Traditional on-pump open CABG surgery has serious side effects, and its preferable alternatives, off-pump and endoscopic CABG surgeries, can be potentially performed for only a small proportion (15-20%) of all CABG surgeries due to technological limitations. The application of the new generation of robotics technology promises a powerful alternative and superior way of performing off-pump CABG surgery. The robotic telesurgical system that will be developed in this project will actively track and cancel the relative motion between the surgical instruments and the heart. The robotic system will also provide the surgeon with dexterous access to operate endoscopically on the anterior, lateral, and posterior surfaces of the heart. This will enable CABG surgeries to be performed endoscopically on a beating heart for a large proportion (80-85%) of all CABG surgeries. The investigators have developed and demonstrated the key enabling technologies in their prior work, including: cardiac motion tracking algorithms, individual sensors for measuring cardiac motion, robotic telesurgical systems, micro-actuators, and force feedback algorithms. Building on this prior work, the proposed research will focus on the following specific aims to achieve this broad objective: i) Development of a sensor system for real-time in vivo measurement of cardiac motion; and ii) In vivo testing and evaluation of cardiac tracking accuracy. PUBLIC HEALTH RELEVANCE: The gold standard method for coronary revascularization remains coronary artery bypass graft (CABG) surgery, a very effective technique for reducing angina and stabilizing ventricular function in coronary artery disease. Approximately 469,000 CABG operations were performed in the U.S in 2005, making it the most common major surgery performed. Traditional on-pump open CABG surgery has serious side effects and its preferable alternatives, off-pump and endoscopic CABG surgeries, can be potentially performed for only a small proportion (15-20%) of all CABG surgeries due to technological limitations. The robotic tools that will be developed in this project will overcome these limitations, and allow a larger fraction (75-80%) of CABG surgeries to be performed totally endoscopic and off-pump with technical perfection equivalent to traditional on- pump open CABG surgeries.