Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Minimally invasive epicardial atrial ablation to cure atrial fibrillation through the use of a percutaneous subxiphoid approach currently has a lack of dedicated technology for intrapericardial navigation around the beating heart. We have developed a novel articulated robotic medical probe and performed preliminary experiments in a porcine preparation. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> In five large, healthy pigs, the teleoperated robotic system was introduced inside the pericardial space through a percutaneous subxiphoid approach. Secondary visualization of the left atrium and left atrial appendage was achieved with the use of a 5-mm scope inserted through a left thoracic port. The operator actively controlled the path of the robot by using a master manipulator. The catheter, with an irrigated radiofrequency tip, was guided through the working port of the robot to achieve epicardial ablation of the left atrium. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Access to the pericardial space and progression around the left atrium was successful in all cases, with no interference with the beating heart such as a fatal arrhythmia, unexpected bleeding, and hypotension. Epicardial ablation was successfully performed in all five cases. No adverse hemodynamic or electrophysiological events were noted during the trials. When the animals were killed, there was no visually detected injury on the surrounding mediastinal structures caused by ablation. Transmural ablation was confirmed by histopathology of the left atrium. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> We have developed a dedicated articulated robotic medical probe and successfully performed epicardial left atrial radiofrequency ablation. Based on the feedback from these preliminary experiments, the radius of curvature and proper visualization of the device are being improved in the next generation prototype. </jats:p></jats:sec>

A stereoscopic fibroscope for camera motion and 3D depth recovery during Minimally Invasive Surgery

“…Example systems include the Highly Articulated Robotic Probe (HARP) for epicardial atrial ablation [5], a "snake" like robotic system designed to provide additional dexterity at the instrument tip for Ear, Nose and Throat (ENT) surgery [6], and a high-dexterity, modular instrument for coronary artery bypass grafting [7]. Systems with alternative white light and fluorescence imaging [8] have also been proposed.…”

A novel highly articulated robotic surgical system for epicardial ablation

“…The current iteration of the RSS made it possible to draw a linear lesion using a commercially available ablation catheter, compared with a single dot lesion by the previous prototype [10]. The current RSS was also able to provide fine and accurate manipulation required by the surgeon while using visualization from the on-board camera.…”

“…The fundamental mechanics of the RSS were described previously [10,11]. Briefly, the RSS is composed of 50 rigid cylindrical links strung together by cables.…”

“…The previous prototypes of the RSS were tested with in-vivo porcine experiments [10,11]. An on-board fiber optic camera was also used to provide visualization for single port access into the intrapericardial space.…”

Single-site access robot-assisted epicardial mapping with a snake robot: preparation and first clinical experience

“…The robot needs only a single point of entry and one hand to steer it to the target site under direct visualization. It contains multiple degrees of freedom distributed across its links and is self-supporting, enabling the robot to traverse nonlinear paths in any three-dimensional space without relying on a lumen or organ to maintain its shape [1–6]. …”