Percutaneous intracardiac beating-heart surgery using metal MEMS tissue approximation tools

Abstract

Achieving superior outcomes through the use of robots in medical applications requires an integrated approach to the design of the robot, tooling and the procedure itself. In this paper, this approach is applied to develop a robotic technique for closing abnormal communication between the atria of the heart. The goal is to achieve the efficacy of surgical closure as performed on a stopped, open heart with the reduced risk and trauma of a beating-heart catheter-based procedure. In the proposed approach, a concentric tube robot is used to percutaneously access the right atrium and deploy a tissue approximation device. The device is constructed using a metal microelectromechanical system (MEMS) fabrication process and is designed to both fit the manipulation capabilities of the robot as well as to reproduce the beneficial features of surgical closure by suture. The effectiveness of the approach is demonstrated through ex vivo and in vivo experiments.

An Autoclavable Steerable Cannula Manual Deployment Device: Design and Accuracy Analysis

“…Typically, prior concentric tube devices have been designed to work as miniature manipulators in open [10] or liquid filled cavities [11]. In applications where these devices act as steerable needles embedded in soft tissues, it is important to design them to be capable of advancing in such a way that the shaft exactly follows the tip's trajectory through tissue.…”

Unified Tracking and Shape Estimation for Concentric Tube Robots

“…With diameter similar to a catheter but with the capability to exercise forces at its distal end due to its increased stiffness, the concentric tube robot has been proposed for several applications that require intracorporeal navigation. For example, Gosline et al [6] investigated cardiosurgical applications, Burgner et al [7] neurosurgical applications, Hendrick et al [8] applied it to transurethral prostate surgery, and Lin et al [9] to eye surgery.…”

Implicit active constraints for safe and effective guidance of unstable concentric tube robots

“…Their size is comparable to that of catheters, but are able to apply distant forces and exhibit shape control. Therefore, they are used in similar clinically-critical interventions, such as navigating the vasculature to reach the heart [3], and snaking through the nasal cavity [4], the unary tracts [5], or the bronchia [6].…”