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

描述(由申请人提供)：拟议研究的长期目标是开发和验证一种机器人远程外科系统，用于执行完全内窥镜非体外循环冠状动脉旁路移植(CABG)手术，而不需要被动稳定。作为一个受重要临床需求推动的技术驱动的转化性研究项目，本研究将专门致力于开发用于体内心脏运动测量的传感器系统，并在体内验证所开发的运动跟踪和心律失常处理技术。CABG手术是美国最常见的大手术，是一种非常有效的冠状动脉血运重建治疗冠心病的技术。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(胸骨)进入心脏。在传统的CABG手术中，心脏停止跳动，并使用体外循环机器为血液充氧，维持体内的血液循环。非体外循环冠状动脉搭桥术是一种替代技术，在心脏仍在跳动的情况下进行手术，而不是使用体外循环机器并停止心脏。内窥镜CABG手术是一种微创技术，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冠状动脉搭桥术有严重的副作用，由于技术的限制，其首选的非体外循环和内窥镜冠状动脉搭桥术可能只适用于所有冠状动脉搭桥术中的一小部分(15%-20%)。新一代机器人技术的应用为非体外循环冠状动脉搭桥术提供了一种强大的替代和优越的方法。该项目将开发的机器人远程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活的通道，以便在心脏的前、侧和后表面进行内窥镜手术。这将使CABG手术在很大比例(80%-85%)的CABG手术中能够在心脏不停跳的内窥镜下进行。研究人员在之前的工作中开发并演示了关键的使能技术，包括：心脏运动跟踪算法、用于测量心脏运动的单个传感器、机器人远程外科系统、微执行器和力反馈算法。在先前工作的基础上，拟议的研究将集中在以下具体目标上，以实现这一广泛的目标：i)开发用于实时活体测量心脏运动的传感器系统；以及ii)活体测试和评估心脏跟踪的准确性。 公共卫生相关性：冠状动脉血运重建的黄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心病心绞痛和稳定心功能的技术。2005年，美国进行了大约46.9万例冠脉搭桥手术，使其成为最常见的大型手术。传统的体外循环开放冠状动脉搭桥术有严重的副作用，由于技术的限制，其首选的非体外循环和内窥镜冠状动脉搭桥术可能只适用于所有冠状动脉搭桥术中的一小部分(15%-20%)。该项目将开发的机器人工具将克服这些限制，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，技术上与传统的在泵开放式CABG手术相当。

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.