Articulated Robot for Epicardial Interventions

描述（由申请人提供）：为了克服目前可用的微创心脏手术（MICS）辅助技术的局限性，我们建议开发和测试一种基于高度铰接式机器人探针（HARP）的创新方法。我们认为，对于涉及对跳动心脏进行心外膜介入的手术，使用HARP可以有效地实现MICS，通过剑突下口进入心包腔，到达心外膜上的远端心包内位置，而不会造成血流动力学和电生理干扰，并在外科医生的直接控制下进行治疗干预。HARP的主要目标是通过利用HARP的高机动性来扩展医生的感知和操作能力，以绕过器官并达到传统刚性和柔性内窥镜工具无法到达的解剖标志。我们选择微创心脏手术作为重点领域，或者更具体地说，我们的目标应用是剑突下视频心包镜检查，因为它代表了大多数手术所面临的所有挑战，并且本身具有显著的优点。在我们看来，作为一个典型的应用，总结了在跳动的心脏上广泛的心外膜干预可能遇到的大多数挑战，我们在此建议测试使用HARP进行左房耳结扎（LAA），这是一种临床相关的方法，可以降低房颤卒中的风险。我们坚信，解决这一示范性应用代表了一个挑战，将增强HARP的功能，并最终导致其应用于多种心包内治疗（例如，通过心包内注射进行细胞移植，心外膜消融，心外膜铅植入进行再同步等）。关于这一临床相关应用，我们假设与现有的硬剑突下视频心包镜技术进行心包内导航相比，HARP将获得更好的结果，而硬剑突下视频心包镜技术将允许LAA结扎。具体目标是进一步发展现有的12mm HARP原型，然后在拟人化幻影、动物和人类尸体中对其进行测试，并将其与现有的剑状下视频心外镜设备进行比较。

DESCRIPTION (provided by applicant): In order to overcome the limitations of currently available assistive technologies for minimally invasive cardiac surgery (MICS), we propose to develop and test an innovative approach based on a highly articulated robotic probe (HARP). We believe that, for procedures involving epicardial interventions on the beating heart, MICS can be effectively realized with the HARP, entering the pericardial cavity through a subxiphoid port, reaching remote intrapericardial locations on the epicardium without causing hemodynamic and electrophysiologic interference and delivering therapeutic interventions under the direct control of the surgeon. The main goal of the HARP is to extend the sensing and manipulation ability of the physician by taking advantage of the high maneuverability of the HARP to steer around organs and reach anatomical landmarks which are not accessible to the conventional rigid and flexible endoscopic tools. We chose minimally cardiac surgery as a focus domain or, more specifically, subxiphoid videopericardioscopy as our target application because it represents all of the challenges that most procedures would have and has significant merit on its own. As an exemplary application that, in our opinion, sums most of the challenges that can be encountered with a broad array of epicardial interventions on the beating heart, we hereby propose to test the use of the HARP for the ligation of the left atrial appendage (LAA), a clinically relevant approach to reduce the risk of stroke in atrial fibrillation. We strongly believe that addressing this exemplary application represents a challenge that will enhance HARP's functionality and will eventually lead to expansion of its application to multiple intrapericardial therapies (e.g. cell transplantation by intramyocardial injection, epicardial ablation, epicardial lead placement for resynchronization, etc). With respect to this clinically relevant application, we hypothesize that the HARP will achieve superior results when compared with the existing rigid subxiphoid videopericardioscopy technology for intrapericardial navigation, which in turn will allow for ligation of LAA.The specific aims are designed to further develop the existing 12mm HARP prototype, and then to test it and comparing it to the existing subxiphoid videopericardioscopy device in an anthropomorphic phantom, in animals and human cadavers. Our broad, long-term objective is to fulfill our group's "epicardial frontier" vision, enabling a growing portfolio of epicardial therapies by developing and testing new dedicated innovative robotic technology. We envision the adoption of HARP-based intrapericardial therapies not only by minimally invasive cardiac surgeons, but also by interventional cardiologists and electrophysiologists. We also believe that the HARP may expand the therapeutic options for other non-cardiac endoscopic applications .