A highly articulated robotic surgical system for minimally invasive surgery

Abstract

Purpose: We developed a novel, highly articulated robotic surgical system (CardioARM) to enable minimally invasive intrapericardial therapeutic delivery through a subxiphoid approach. We performed preliminary proof of concept studies in a porcine preparation by performing epicardial ablation.

Description: CardioARM is a robotic surgical system having an articulated design to provide unlimited but controllable flexibility. The CardioARM consists of serially connected, rigid cyclindrical links housing flexible working ports through which catheter-based tools for therapy and imaging can be advanced. The CardioARM is controlled by a computer-driven, user interface, which is operated outside the operative field.

Evaluation: In six experimental subjects, the CardioARM was introduced percutaneously through a subxiphoid access. A commercial 5-French radiofrequency ablation catheter was introduced through the working port, which was then used to guide deployment. In all subjects, regional ("linear") left atrial ablation was successfully achieved without complications.

Conclusions: Based on these preliminary studies, we believe that the CardioARM promises to enable deployment of a number of epicardium-based therapies. Improvements in imaging techniques will likely facilitate increasingly complex procedures.

Fig 1

(A) Distal apparatus of the CardioARM consisting of cylindrical links articulated by spherical joints. (B) The feeder instrumentation box contains all mechanics necessary for probe manipulation, which includes motors for controlling the cables and actuators for the driving system.

Fig 2

Intraoperative pictures during porcine trials. (A) The CardioARM is mounted on the operating table using a custom mounting frame. The onboard optic fiber view is displayed on the monitor (arrow). (B) A small subxiphoid incision and small pericardiotomy are manually made under direct visualization. The distal apparatus of the CardioARM passes through the pericardiotomy.

Fig 3

The accomplished courses of the distal apparatus of the CardioARM in the navigation trials. (A) Front view. (B) Left lateral view. (#1 = superior vena cava; #2 = right atrial appendage; #3 = ascending aorta; #4 = left atrial appendage; #5 = transverse sinus; #6 = atrioventricular groove.)

Fig 4

(A) A picture of the onboard view during the epicardial ablation trials. (B) The distal apparatus of the CardoARM is seen through the pericardium (arrow). The tip of the robot is navigated to the left atrial appendage over the lateral wall of the heart. A left thoracotomy was created only for photographing probe movement. (C) A linear “dot-to-dot” lesion at the base of the left atrial appendage of the excised heart. (LAA = left atrial appendage.)