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

描述（由申请人提供）：拟定研究的长期目标是开发和确认一种用于在无被动稳定的情况下进行全内窥镜非体外循环冠状动脉旁路移植术（CABG）手术的机器人外科手术系统。作为一个技术驱动的转化研究项目的动机是一个重要的临床需求，在本研究中的研究将特别集中在传感器系统的发展，在体内测量心脏运动，并在体内验证的运动跟踪和心律失常处理的开发技术。冠状动脉旁路移植术是一种非常有效的冠状动脉血运重建技术，用于治疗冠状动脉疾病，是美国最常见的大手术。传统的冠状动脉旁路移植术是一种开胸手术，通过切开胸骨进入心脏。在传统的CABG手术中，心脏停止，并且使用心肺转流机来灌注血液并维持体内的血液循环。非体外循环CABG手术是一种替代技术，在心脏仍在跳动时进行手术，而不是使用心肺转流机和停止心脏。内窥镜CABG手术是一种微创技术，用于使用通过小切口插入的器械进行CABG手术，而不是打开胸骨。传统的体外循环开放式CABG手术具有严重的副作用，并且由于技术限制，其优选的替代方案，非体外循环和内窥镜CABG手术可能仅用于所有CABG手术的一小部分（15-20%）。新一代机器人技术的应用为非体外循环冠状动脉旁路移植术提供了一种强有力的替代和上级方法。本项目中将开发的机器人外科手术系统将主动跟踪和消除手术器械与心脏之间的相对运动。机器人系统还将为外科医生提供灵巧的通道，以便在心脏的前表面、侧表面和后表面上进行内窥镜手术。这将使大部分（80-85%）的CABG手术能够在跳动的心脏上通过内窥镜进行。研究人员已经开发并展示了他们先前工作中的关键技术，包括：心脏运动跟踪算法，用于测量心脏运动的单个传感器，机器人手术系统，微致动器和力反馈算法。在此之前的工作的基础上，拟议的研究将集中在以下具体目标，以实现这一广泛的目标：i）开发一种传感器系统，用于心脏运动的实时体内测量;和ii）心脏跟踪精度的体内测试和评估。 公共卫生相关性：冠状动脉血运重建的金标准方法仍然是冠状动脉旁路移植术（CABG），这是一种非常有效的减少冠状动脉疾病心绞痛和稳定心室功能的技术。2005年在美国进行了大约469，000例CABG手术，使其成为最常见的大手术。传统的体外循环开放式CABG手术具有严重的副作用，并且由于技术限制，其优选的替代方案，非体外循环和内窥镜CABG手术可能仅用于所有CABG手术的一小部分（15-20%）。本项目中将开发的机器人工具将克服这些限制，并允许更大比例（75-80%）的CABG手术完全在内窥镜下和非体外循环下进行，其技术完美性等同于传统的体外循环开放式CABG手术。

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.