Robot-Assisted Cardiac Surgery

Abstract

The significant advantages of minimizing surgical trauma, such as reduced pain, shorter hospital stays, faster return to normal activities, and improved cosmesis, have resulted in the development of minimally invasive surgery. 1) Until recently, various difficulties associated with endoscopic approaches had stalled similar progress in the field of cardiac surgery. However, robotic technology overcame the difficulties associated with conventional endoscopic surgery and has made possible a new approach to minimally invasive cardiac surgery.The application of robot-assisted coronary surgery ranges from internal mammary artery (IMA) harvesting with handsewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB) either on-or off-pump. The bilateral IMAs can be harvested with the aid of a surgical robot, and then multivessel bypass grafting can follow. Srivastava calls such robot-assisted minimally invasive direct coronary artery bypass grafting (MIDCAB) "ThoraCAB.'' 2) Surgical robots can not only endoscopically harvest the IMA, but they can also anastomose the coronary artery in TECAB.On the other hand, closed-chest cardiopulmonary bypass (CPB) and cardioplegic arrest have stimulated the development of minimally invasive cardiac surgery (MICS) via a small thoracotomy, 3) and this has now become universal, especially to treat valve diseases and congenital structural heart diseases. Endoscopic techniques are also required for MICS, but conventional endoscopic instrumentation lacks the dexterity required for delicate cardiac surgical procedures, and the loss of depth perception caused by twodimensional monitors further increases operative obstacles.Surgical robots have been developed to enhance surgical ability and precision, and to repair structural heart conditions, including mitral valve plasty (MVP), atrial septal defect closure, cardiac tumour resection, ThoraCAB, and TECAB. The most common applications in cardiac surgery are MVP and endoscopic coronary artery bypass grafting (CABG). da Vinci Surgical SystemThe da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) comprises a surgeon's console, a Robot-Assisted Cardiac SurgeryNorihiko Ishikawa, MD, PhD and Go Watanabe, MD, PhD Recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery offers patients the benefits of minimally invasive surgery, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically rather than through a median sternotomy during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB), and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. Robot-assisted cardi...

ECG Monitoring Systems: Review, Architecture, Processes, and Key Challenges

“…On the other hand, advancements in robotics introduced new opportunities for cardiac healthcare, especially with the great challenge of limited medical resources. Some researchers investigated the dimensions of the practical use of robotic-assisted heart surgeries [217,266]. Others studied the possibility of having a robot assistant providing medical feedback, diagnosis, and notifications [267,268].…”

Solving the Time-Varying Inverse Kinematics Problem for the Da Vinci Surgical Robot

“…In addition, we know that E = U −1 U. Left-multiply the inverse of unitary matrix U −1 and right-multiply the matrix U on both sides of Equation (4). Then, multiply the E matrix between these two matrices to transform Equation (4) into the following:…”

“…The Da Vinci robotic system consists of three components: the surgeon console (master manipulators), the patient trolley (slave manipulators), and the imaging system [3]. The surgeon manipulates two master handles at the master remote console, which can acquire high-resolution, binocular, three-dimensional, magnified views of the operative field as compared with open surgery [4]. However, this kind of master-slave operation mode poses a great challenge to the real-time and accurate performance of the master-slave mapping control, among which the inverse kinematics problem is the first obstacle.…”

Microcirculatory Coherence in Patients with Left Ventricular Assist Devices

“…We recently read with interest the review by Stone et al on left ventricular assist devices (LVADs). 1 One important point that was not discussed in the review was microcirculatory blood flow during nonpulsatile or minimally pulsatile LVAD support. Maintenance of the microcirculation (ie, proportion of perfused vessels, or microcirculatory flow index [MFI]) with parallel maintenance of macrocirculatory hemodynamics (eg, blood pressure) has been termed hemodynamic coherence.…”