Cardioscopic Tool-Delivery Instrument for Beating-Heart Surgery

Ataollahi, Asghar; Berra, Ignacio; Vasilyev, Nikolay V.; Machaidze, Zurab; Dupont, Pierre E.

doi:10.1109/tmech.2015.2494842

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…The ACT delivery experiments reported herein are the first to investigate optically guided off-pump tissue grasping and leaflet manipulation. Previous work using off-pump optical guidance has shown its efficacy in positioning the tip of the imaging instrument on intracardiac tissue to perform diagnostics 12,13,16 or to deploy anchors, 14 tools, 17 and devices 18 directly onto or into the tissue, but has not considered tissue grasping or leaflet manipulation.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11] Current clinical minimally invasive techniques deliver artificial chordae tendineae (ACT) using transesophageal echocardiography as the primary imaging modality to guide chordal placement. Although endoscopic techniques have shown promise for beating-heart interventions, [12][13][14][15][16][17][18] optically guided off-pump tissue grasping and mitral valve repair have not been previously investigated. In this report, we explore the use of endoscopically-guided mitral leaflet segment localization, grasping, and neochordal implantation.…”

Section: Perspectivementioning

confidence: 99%

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Optically-guided instrument for transapical beating-heart delivery of artificial mitral chordae tendineae

Machaidze¹,

Mencattelli²,

Arnal³

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: We sought to develop an instrument that would enable the delivery of artificial chordae tendineae (ACT) using optical visualization of the leaflet inside the beating heart.Methods: A delivery instrument was developed together with an ACT anchor system. The instrument incorporates an optically clear silicone grasping surface in which are embedded a camera and LED for direct leaflet visualization during localization, grasping, and chordal delivery. ACTs, comprised of T-shaped anchors and an expanded polytetrafluoroethylene chordae, were fabricated to enable testing in a porcine model. Ex vivo experiments were used to measure the anchor tear-out force from the mitral leaflets. In vivo experiments were performed in which the mitral leaflets were accessed transapically using only optical guidance and ACTs were deployed in the posterior and anterior leaflets (P2 and A2 segments).Results: In 5 porcine ex vivo experiments, the mean force required to tear the anchors from the leaflets was 3.8 AE 1.2 N. In 5 porcine in vivo nonsurvival procedures, 14 ACTs were successfully placed in the leaflets (9 in P2 and 5 in A2). ACT implantation took an average of 3.22 AE 0.83 minutes from entry to exit through the apex.Conclusions: Optical visualization of the mitral leaflet during chordal placement is feasible and provides direct feedback to the operator throughout the deployment sequence. This enables visual confirmation of the targeted leaflet location, distance from the free edge, and successful deployment of the chordal anchor. Further studies are needed to refine and assess the device for clinical use.

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Section: Discussionmentioning

confidence: 99%

Section: Perspectivementioning

confidence: 99%

Optically-guided instrument for transapical beating-heart delivery of artificial mitral chordae tendineae

Machaidze¹,

Mencattelli²,

Arnal³

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…Benefits of surgical robotic platforms span a variety of applications, from cardiovascular interventions (e.g., precise positioning in cardiac mapping, radiofrequency ablation, and valve repair) (3,4) to orthopedic surgery (e.g., heightened force generation for hip replacement) (5). Surgical robotic platforms have also been developed by multiple research groups to facilitate minimally invasive approaches in hard-to-navigate areas of the body (6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

A multifunctional soft robot for cardiac interventions

Rogatinsky,

Recco,

Feichtmeier

et al. 2023

Sci. Adv.

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In minimally invasive endovascular procedures, surgeons rely on catheters with low dexterity and high aspect ratios to reach an anatomical target. However, the environment inside the beating heart presents a combination of challenges unique to few anatomic locations, making it difficult for interventional tools to maneuver dexterously and apply substantial forces on an intracardiac target. We demonstrate a millimeter-scale soft robotic platform that can deploy and self-stabilize at the entrance to the heart, and guide existing interventional tools toward a target site. In two exemplar intracardiac procedures within the right atrium, the robotic platform provides enough dexterity to reach multiple anatomical targets, enough stability to maintain constant contact on motile targets, and enough mechanical leverage to generate newton-level forces. Because the device addresses ongoing challenges in minimally invasive intracardiac intervention, it may enable the further development of catheter-based interventions.

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“…Usually, medical workers can obtain an initial diagnosis according to the spatial images detected with an endoscopy system. However, the propagation of light within the tissue [17] and optical imaging through blood inside the heart [18] are significant problems in diagnostic approaches and medical applications.…”

Section: Introductionmentioning

confidence: 99%

Design of a real-time fiber-optic infrared imaging system with wide-angle and large depth of field

Peng

2022

中国光学快报

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A key limitation in the observation of instruments used in operations and heart sutures during a procedure is the scattering and absorption during optical imaging in the presence of blood. Therefore, we propose a novel real-time fiber-optic infrared imaging system simultaneously capturing a flexible wide field of view (FOV) and large depth of field infrared image in real time. The assessment criteria for imaging quality of the objective and coupling lens have been optimized and evaluated. Furthermore, the feasibility of manufacturing and assembly has been demonstrated with tolerance sensitivity and the Monte Carlo analysis. The simulated results show that the optical system can achieve a large working distance of 8 to 25 mm, a wide FOV of 120°, and the relative illuminance is over 0.98 in the overall FOV. To achieve high imaging quality in the proposed system, the modulation transfer function is over 0.661 at 16.7 lp/mm for a 320 × 256 short wavelength infrared camera sensor with a pixel size of 30 μm.

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Cardioscopic Tool-Delivery Instrument for Beating-Heart Surgery

Cited by 6 publications

References 19 publications

Optically-guided instrument for transapical beating-heart delivery of artificial mitral chordae tendineae

Optically-guided instrument for transapical beating-heart delivery of artificial mitral chordae tendineae

A multifunctional soft robot for cardiac interventions

Design of a real-time fiber-optic infrared imaging system with wide-angle and large depth of field

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