Articulated Robot for Epicardial Interventions

描述(由申请人提供)：为了克服目前可用于微创心脏手术(MICS)的辅助技术的局限性，我们建议开发和测试一种基于高关节机器人探头(HARP)的创新方法。我们认为，对于涉及心脏不停跳心外膜介入的手术，MICS可以通过HARP有效地实现，通过剑下孔进入心包腔，到达心外膜上遥远的心包内位置，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。HARP的主要目标是通过利用HARP的高度机动性来引导器官周围并到达传统刚性和柔性内窥镜工具无法到达的解剖地标，从而扩展医生的感知和操作能力。我们选择最小心脏手术作为重点领域，或者更具体地说，剑形下视频心包镜作为我们的目标应用，因为它代表了大多数手术将面临的所有挑战，并且本身具有显著的优点。作为一个示范性应用，在我们看来，总结了在心脏跳动中进行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HARP用于左心耳(LAA)结扎的使用，这是一种临床相关的方法，可以降低心房颤动中中风的风险。我们坚信，解决这一示范性应用是一项挑战，它将增强HARP的功能，并最终将其应用扩展到多种心包内治疗(例如，通过心肌内注射进行细胞移植、心外膜消融、心外膜导联再同步放置等)。对于这一临床相关的应用，我们假设HARP与现有的用于心包内导航的刚性剑形下视频心包镜技术相比将获得更好的结果，这反过来将允许结扎LA。具体目的是进一步开发现有的12 mm HARP原型，然后在动物和人类身体上测试它并将其与现有的剑形下视频心包镜设备进行比较。 我们广泛的长期目标是实现我们集团的“心外膜前沿”愿景，通过开发和测试新的专用创新机器人技术，实现不断增长的心外膜治疗组合。我们设想，基于HARP的心包内治疗不仅将被微创心脏外科医生采用，而且将被介入性心脏病学家和电生理学家采用。我们还认为，HARP可能会扩大其他非心脏内窥镜应用的治疗选择。

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 .