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

全内窥镜非体外循环冠状动脉旁路手术机器人工具的开发

基本信息

批准号：
8064798
负责人：
M. Cenk Cavusoglu
金额：
$ 19.63万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-05-01 至 2013-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8064798
关键词：
Adverse effects Algorithms Anterior Arrhythmia Blood Blood Circulation Cardiac Cardiac Surgery procedures Cardiopulmonary Bypass Chest Clinical Coronary Coronary Arteriosclerosis Coronary Artery Bypass Coronary artery Development Effectiveness Evaluation Feedback Generations Goals Gold Heart Housing Image Individual Lateral Left Measurement Measures Methods Modeling Motion Off-Pump Coronary Artery Bypass Operating Rooms Operative Surgical Procedures Performance Procedures Pump Real-Time Systems Relative (related person)Research Research Personnel Research Project Grants Robot Robotics Site Sternum Study Section Surface Surgeon Surgical Instruments Surgical incisions System Techniques Technology Translational Research Treatment Effectiveness United States Validation Ventricular Function Work arm base bone design evaluation/testing heart motion in vivo instrument minimally invasive operation preclinical study public health relevance research study sensor technology development technology validation tool

项目摘要

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.

描述（由申请人提供）：拟议研究的长期目标是开发和验证机器人远程手术系统，用于在没有被动稳定的情况下执行完全内窥镜非体外循环冠状动脉旁路移植术（CABG）手术。作为一个由重要临床需求推动的技术驱动的转化研究项目，本研究将特别关注开发用于体内测量心脏运动的传感器系统，以及对已开发的运动跟踪技术进行体内验证，和心律失常处理。 CABG 手术是一种非常有效的冠状动脉血运重建技术，用于治疗冠状动脉疾病，是美国最常见的大手术。传统的 CABG 是一种开胸手术，通过切开胸骨（胸骨）进入心脏。传统的CABG手术中，心脏停止跳动，利用体外循环机给血液充氧，维持体内血液循环。非体外循环冠状动脉搭桥手术是一种替代技术，在心脏仍在跳动时进行手术，而不是使用体外循环机并使心脏停止跳动。内窥镜冠状动脉搭桥手术是一种微创技术，使用通过小切口插入的器械而不是打开胸骨来进行冠状动脉搭桥手术。传统的体外循环开放式CABG手术具有严重的副作用，而其更好的替代方案，即非体外循环和内镜下CABG手术，由于技术限制，可能仅占所有CABG手术的一小部分（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手术提供了一种强大的替代方案和优越的方法。该项目将开发的机器人远程手术系统将主动跟踪并消除手术器械与心脏之间的相对运动。该机器人系统还将为外科医生提供灵巧的途径，以便通过内窥镜对心脏的前表面、侧表面和后表面进行手术。这将使所有 CABG 手术中的很大一部分 (80-85%) 能够通过内窥镜在跳动的心脏上进行 CABG 手术。研究人员在之前的工作中开发并展示了关键的支持技术，包括：心脏运动跟踪算法、用于测量心脏运动的单独传感器、机器人远程手术系统、微执行器和力反馈算法。基于先前的工作，拟议的研究将重点关注以下具体目标，以实现这一广泛目标：i）开发用于实时体内测量心脏运动的传感器系统； ii) 心脏追踪准确性的体内测试和评估。公众健康相关性：冠状动脉血运重建的金标准方法仍然是冠状动脉旁路移植术（CABG）手术，这是一种非常有效的技术，可以减少冠状动脉疾病的心绞痛和稳定心室功能。 2005 年，美国进行了大约 469,000 例 CABG 手术，使其成为最常见的大手术。传统的体外循环开放式 CABG 手术具有严重的副作用，而其更好的替代方案，即非体外循环和内窥镜 CABG 手术，由于技术限制，可能仅适用于所有 CABG 手术的一小部分 (15-20%)。该项目将开发的机器人工具将克服这些限制，并允许大部分（75-80%）的 CABG 手术完全通过内窥镜和非体外循环进行，其技术完善程度相当于传统的体外循环开放式 CABG 手术。