Robotic Crawler for Epicardial Interventions

描述（由申请人提供）： 由于正中胸骨切开术和心肺转流术的并发症，心脏不停跳下的内镜手术已成为一个主要的研究目标。跳动的心脏的运动对精确操纵造成了重大问题。此外，用于微创心脏手术的大多数现有技术涉及使用胸腔镜切口和刚性内窥镜，使得进入心外膜的某些部分非常成问题。 我们假设，对于许多临床手术，可以通过开发一种微型可拆卸机器人设备来同时解决心脏跳动运动和完全心外膜进入的问题，该设备使用吸力粘附在心脏上，并像尺蠖一样在表面上移动，仅通过电线或系绳与外部世界连接以进行通信和供电。由于该器械可以移动到心外膜表面的任何所需点，因此可以使用剑突下视频心包镜入路代替胸腔镜。因此，不需要选择性肺通气。通过避免气管内插管，该技术将允许使用局部或区域而不是全身麻醉，为某些程序的门诊心脏手术创造了可能性。 潜在的临床应用是众多的;作为示例性应用，我们提出在心肌注射中展示该技术，例如用于递送成肌细胞以进行心脏血运重建。具体目标是： 1.开发一种独立的可拆卸拴系心外膜爬行装置（HeartLander），可通过内窥镜进入心包，将其自身连接到不受约束的跳动心脏上，并在外科医生指定的任何位置进行机动以建立适当稳定的工作部位。 2.开发必要的外科末端执行器或工具，使HeartLander能够准确地注射到心肌中。 3.在拟人心脏跳动体模或假人中对该技术进行临床前测试。 4.在猪模型中测试该技术的体内安全性和能力。

DESCRIPTION (provided by applicant): Endoscopic surgery on the beating heart has become a major research objective due to the morbidity associated with median sternotomy and cardiopulmonary bypass. The motion of the beating heart creates significant problems for ac- curate manipulation. In addition, most existing techniques for minimally invasive cardiac surgery involve the use of thoracoscopic incisions and rigid endoscopes, making access to certain parts of the epicardium highly problematic. We hypothesize that for many clinical procedures the problems of beating heart motion and full epicardial access can be solved simultaneously by developing a miniature detachable robotic device that adheres to the heart using suction and travels like an inchworm across the surface, connected to the outside world only by a wire or tether for communication and power. Because this device can move to any desired point on the epicardial surface, a subxiphoid videopericardioscopic approach can be used instead of thoracoscopy. As a result, selective lung ventilation is not needed. By obviating endotracheal intubation, this technology will allow the use of local or regional rather than general anesthesia, creating the potential for ambulatory outpatient cardiac surgery for certain procedures. Potential clinical applications are numerous; as an exemplary application we propose to demonstrate the technology in myocardial injection, such as is used for delivery of myoblasts for cardiac revascularization. The specific aims are to: 1. Develop a self-contained detachable tethered epicardial crawling device (HeartLander) that can enter the pericardium via endoscope, attach itself to the unconstrained beating heart, and maneuver itself to establish a suitably stable worksite at any location specified by the surgeon. 2. Develop the necessary surgical end-effectors or tools to enable the HeartLander to perform accurate injections into the myocardium. 3. Test the technology preclinical in an anthropomorphic beating-heart phantom or dummy. 4. Test the safety and capability of the technology in vivo in a porcine model.