Robotic assistance enhances conventional endoscopy; yet, limitations have hindered its mainstream adoption for cardiac surgery. HeartLander is a miniature mobile robot that addresses several of these limitations by providing precise and stable access over the surface of the beating heart in a lessinvasive manner. The robot adheres to the heart and navigates to any desired target in a semiautonomous fashion. The initial therapies considered for HeartLander generally require precise navigation to multiple surface targets for treatment. To balance speed and precision, we decompose any general target acquisition into navigation to the target region followed by fine positioning to each target. In closed-chest, beating-heart animal studies, we demonstrated navigation to targets located around the circumference of the heart, as well as acquisition of target patterns on the anterior and posterior surfaces with an average error of 1.7 mm. The average drift encountered during stationkeeping was 0.7 mm. These preclinical results demonstrate the feasibility of precise semiautonomous delivery of therapy to the surface of the beating heart using HeartLander.
Background-We have developed a novel miniature robotic device (HeartLander) that can navigate on the surface of the beating heart through a subxiphoid approach. This study investigates the ability of HeartLander to perform in vivo semiautonomous epicardial injections on the beating heart. Methods and Results-The inchworm-like locomotion of HeartLander is generated using vacuum pressure for prehension of the epicardium and drive wires for actuation. The control system enables semiautonomous target acquisition by combining the joystick input with real-time 3-dimensional localization of the robot provided by an electromagnetic tracking system. In 12 porcine preparations, the device was inserted into the intrapericardial space through a subxiphoid approach. Ventricular epicardial injections of dye were performed with a custom injection system through HeartLander's working channel.HeartLander successfully navigated to designated targets located around the circumference of the ventricles (mean path lengthϭ51Ϯ25 mm; mean speedϭ38Ϯ26 mm/min). Injections were successfully accomplished following the precise acquisition of target patterns on the left ventricle (mean injection depthϭ3.0Ϯ0.5 mm). Semiautonomous target acquisition was achieved within 1.0Ϯ0.9 mm relative to the reference frame of the tracking system. No fatal arrhythmia or bleeding was noted. There were no histological injuries to the heart due to the robot prehension, locomotion, or injection. Conclusions-In this proof-of-concept study, HeartLander demonstrated semiautonomous, precise, and safe target acquisition and epicardial injection on a beating porcine heart through a subxiphoid approach. This technique may facilitate minimally invasive cardiac cell transplantation or polymer therapy in patients with heart failure. (Circulation. 2008;118[suppl 1]:S115-S120.)
Background HeartLander is a miniature mobile robot designed to navigate over the epicardium of the beating heart for minimally invasive therapy. This paper presents a technique to decrease slippage and improve locomotion efficiency by synchronizing the locomotion with the intrapericardial pressure variations of the respiration and heartbeat cycles. Methods Respiratory and heartbeat phases were detected in real time using a chest-mounted accelerometer during locomotion in a porcine model in vivo. Trials were conducted over the lateral aspect of the heart surface to test synchronized locomotion against an unsynchronized control. Results Offline evaluation showed that the respiration and heartbeat algorithms had accuracies of 100% and 88%, respectively. Synchronized trials exhibited significantly lower friction, higher efficiency, and greater total distance traveled than control trials. Conclusion Synchronization of the locomotion of HeartLander with respiration and heartbeat is feasible and results in safer and more efficient travel on the beating heart.
This article describes the development and preliminary testing of a mobile robotic device to facilitate minimally invasive beating-heart intrapericardial intervention. The HeartLander robot will be introduced beneath the pericardium via subxiphoid incision, adhere to the epicardium, navigate to any location, and administer therapy under the control of the physician. As compared to current robotic cardiac surgical techniques, this novel paradigm obviates immobilization of the heart and eliminates access limitations. Furthermore, it does not require lung deflation and differential ventilation and thus could enable outpatient cardiac surgery. The current HeartLander prototypes use suction to maintain prehension of the epicardium and wire actuation to perform locomotion. A fiber optic videoscope displays visual feedback to the physician, who controls the device through a joystick interface. The initial prototype demonstrated successful prehension, turning, and locomotion on open-chest, beating-heart porcine models where the pericardium was removed (N = 3). A smaller second-generation prototype with an injection system demonstrated locomotion and myocardial injection of dye, both performed with the pericardium intact (N = 3). These trials illustrate the feasibility of using a miniature mobile robot to navigate upon the beating heart and perform intrapericardial therapy.
Abstract. This paper describes the development and preliminary testing of a robotic device to facilitate minimally invasive beating-heart intrapericardial interventions. We propose the concept of a subxiphoid-inserted mobile robot (HeartLander) with the ability to adhere to the epicardium, navigate to any location, and administer therapy under physician control. As compared to current laparoscopic cardiac surgical techniques, this approach obviates cardiac stabilization and eliminates access limitations. Additionally, it does not require lung deflation and differential lung ventilation, and thus could open the way to outpatient cardiac therapies. The current HeartLander prototype uses suction to maintain prehension of the epicardium and wire actuation to perform locomotion. A fiber optic videoscope displays visual feedback to the physician, who controls the device through a joystick interface. A working channel provides access for the insertion of various therapeutic tools. This prototype has demonstrated successful prehension and walking during open-chest beating-heart porcine trials.
This article describes the development and preliminary testing of a mobile robotic device to facilitate minimally invasive beating-heart intrapericardial intervention. The HeartLander robot will be introduced beneath the pericardium via subxiphoid incision, adhere to the epicardium, navigate to any location, and administer therapy under the control of the physician. As compared to current robotic cardiac surgical techniques, this novel paradigm obviates immobilization of the heart and eliminates access limitations. Furthermore, it does not require lung deflation and differential ventilation and thus could enable outpatient cardiac surgery. The current HeartLander prototypes use suction to maintain prehension of the epicardium and wire actuation to perform locomotion. A fiber optic videoscope displays visual feedback to the physician, who controls the device through a joystick interface. The initial prototype demonstrated successful prehension, turning, and locomotion on open-chest, beating-heart porcine models where the pericardium was removed (N = 3). A smaller second-generation prototype with an injection system demonstrated locomotion and myocardial injection of dye, both performed with the pericardium intact (N = 3). These trials illustrate the feasibility of using a miniature mobile robot to navigate upon the beating heart and perform intrapericardial therapy.
The development and preliminary testing of a device for facilitating minimally invasive beating-heart intrapericardial interventions are described. We propose the concept of an endoscopic robotic device that adheres to the epicardium by suction and navigates by crawling like an inchworm to any position on the surface under the control of a surgeon. This approach obviates cardiac stabilization, lung deflation, differential lung ventilation, and reinsertion of laparoscopic tools for accessing different treatment sites, thus offering the possibility of reduced trauma to the patient. The device has a working channel through which various tools can be introduced for treatment. The current prototype demonstrated successful prehension, turning, and locomotion on beating hearts in a limited number of trials in a porcine model.
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