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

Abstract

CardioARM, a highly flexible “snakelike” medical robotic system (Medrobotics, Raynham, MA), has been developed to allow physicians to view, access, and perform complex procedures intrapericardially on the beating heart through a single-access port. Transthoracic epicardial catheter mapping and ablation has emerged as a strategy to treat arrhythmias, particularly ventricular arrhythmias, originating from the epicardial surface. The aim of our investigation was to determine whether the CardioARM could be used to diagnose and treat ventricular tachycardia (VT) of epicardial origin. Animal and clinical studies of the CardioARM flexible robot were performed in hybrid surgical–electrophysiology settings. In a porcine model study, single-port pericardial access, navigation, mapping, and ablation were performed in nine animals. The device was then used in a small, single-center feasibility clinical study. Three patients, all with drug-refractory VT and multiple failed endocardial ablation attempts, underwent epicardial mapping with the flexible robot. In all nine animals, navigation, mapping, and ablation were successful without hemodynamic compromise. In the human study, all three patients demonstrated a favorable safety profile, with no major adverse events through a 30-day follow-up. Two cases achieved technical success, in which an electroanatomic map of the epicardial ventricle surface was created; in the third case, blood obscured visualization. These results, although based on a limited number of experimental animals and patients, show promise and suggest that further clinical investigation on the use of the flexible robot in patients requiring epicardial mapping of VT is warranted.Electronic supplementary materialThe online version of this article (doi:10.1007/s11701-012-0343-6) contains supplementary material, which is available to authorized users.

Finite Element Analysis and Design Optimization of a Pneumatically Actuating Silicone Module for Robotic Surgery Applications

“…S oft robotics is a new field of robotic engineering 1,2 that furthers the design of flexible robots consisting of an actuating chain of multiple stiff nodes. 3 Soft robots have the potential to be used in surgical applications, 2,4,5 as the fluidlike flexibility and soft materials of these robots offer them the advantage of being able to navigate through narrow passages between organs with minimum harm to the organ soft tissue, covering outer membrane and vascular blood supply. Elastomer-based robotics have shown great promise in developing robots that mimic the muscular hydrostatic systems found in nature 6,7 such as the octopus tentacles, 8,9 caterpillars, 10 jelly fish and asteroids, 11 and elephant trunk.…”

Hand-Eye-Force Coordination of Acupuncture Robot

“…In recent years, the development of surgical robot is rapid, the robot Da Vinci developed by Intuitive Surgical played an important role in Surgical work [7], [8]. ZEUS robot developed by Computer Motion [9], ROSA robot developed by Medtech [10], Magellan robot developed by Hansen Medical [11],and CardioArm robot from Carnegie Mellon University [12] played important roles in medicine. The development of these surgical robots provides important reference and hardware support for the realization of acupuncture robots.…”

“…+ 0.002) + 0.098, (12) where the object with different forces. The actual and estimated values of the force are shown in Fig.…”

Transoral surgery for oropharyngeal tumors using the Medrobotics® Flex® System – a case report

“…The Medrobotics ® Flex ® System (Medrobotics Corp., Raynham, MA – USA) is an operator controlled flexible endoscope that includes a flexible endoscope and computer-assisted controllers, consisting of numerous articulating segments that are capable of rotating and provide lateral motion [7,8] . The endoscope is comprised of two segments, an inner and outer segment, which are arranged in a concentric mechanical assembly to form the endoscope.…”