Robot Assisted Cardiac Surgery Course: Cardiovascular Imaging Submitted by: Alper Yaman Instructor: Assoc. Prof. Dr. Cengizhan Öztürk

What is robot assisted surgery? Application of computer assisted robotics to enhance surgeon’s capability to carry out various “minimally invasive” surgical procedures.

The advantages of robotic surgery Faster, easier and steadier surgery More accuracy Enhanced visualisation, zooming Minimally invasive [1].

The advantages of robotic surgery 2 Less pain to patient Shorter recovery time Shorter hospital stays [1]

Robot Assisted Surgery Approach Perception & imaging by sensors and cameras to monitor the heart

Robot Assisted Surgery Approach 2 Arms and wrists for clamping, suturing, and severing. Control Panel

Technical Information Registration Preoperative images (CT or MRI) are registered both to stabilize target point images on the monitor and to guide the manipulators [2]. Imaging Fast video cameras are used to obtain operative images.

Technical Information 2 Robot Positioning Optimal position of the robot should be provided concerning with degrees of freedom of the manipulator [2].

Technical Information 3 Port Placement: Entry points are selected by images on the port. Robot is registered to the patient. Ports are expressed in the robot coordinate frame and used to guide the surgeon [2].

Heart Beat Synchronization “Motion Cancelling Robot System” Visual Synchronization: Provides stabilized target point images on the monitor. Motion Synchronization: The slave robot is synchronized with the heart beat. Master – Slave Control: Transfers the master motion to control the slave robot [3].

Heart Beat Synchronization “Motion Cancelling Robot System” [3]

Haptics and Augmented Reality Haptics Applying tactile sensation and control to interaction with computer applications. Augmented Reality Computer graphics are superimposed or composited with real images.

Haptic Virtual Fixtures Software-generated force and position signals applied to human operators. To improve the safety, accuracy, and speed of manipulation tasks. Integrates robots accuracy and precision with human intelligence [4].

Haptic Virtual Fixtures 2 Guidance Virtual Fixtures: guides the robot along desired paths (a). Forbidden-Region Virtual Fixtures: Keep the robot out of forbidden regions (b). [4] [4]

An example to robots “Da Vinci Surgical System” Intuitive nature of the surgeon’s hand movements Components: A surgeon console Patient-side cart Instruments Image processing equipment

An example to robots “Da Vinci Surgical System” 2 Benefits For The Surgeon: Improved dexterity Enhanced 3D visualisation and magnification Greater surgical precision Increased range of motion Better ergonomics

An example to robots “Da Vinci Surgical System” 3 Robotic articulated instrumentation daVinci prototype 1997 [5]

An example to robots Leipzig 1998 [5]

Current Operations with daVinci Atrial septal defect closure Internal thoracic artery take-down Endoscopic coronary bypass LV bipolar pacing lead placement Mitral valve repairment and replacement Ablation of atrial fibrillation [5]

Current Operations with daVinci 2 [5]

Current Operations with daVinci 3 [5]

Transmyocardial Revascularization Laser is used to open tiny holes (transmyocardial channels) on myocardium. Angiogenesis: Laser stimulates new blood vessels to grow. Channels heal on the outside but remain open on the inside. [6]

Transmyocardial Revascularization 2 [6]

Results and Discussion Robot assisted cardiac surgery is combining various disciplines: robotics, computer vision and biomedical engineering. It’s advantages are: Faster, easier and steadier surgery More accuracy Enhanced visualisation, zooming Minimally invasive Less pain to patient Shorter recovery time Shorter hospital stays

References 1. E. Adams, Bibliography: Robotic Surgery, Technology Assessment Program, Office of Patient Care Services, Boston, March `E. Coste-Mani`ere and L. Adhami. Optimal Planning of Robotically Assisted Heart Surgery: Transfer Precision in the Operating Room. The International Journal of Robotics Research, Vol. 23, No. 4-5, (2004). 3. Y. Nakamura, K. Kishi, and H. Kawakami. Heartbeat Synchronization for Robotic Cardiac Surgery. Proc. of the IEEE. International Conf. On Robotics&Automation, pp , J. J. Abbott, P. Marayong, and A. M. Okamura, "Haptic Virtual Fixtures for Robot-Assisted Manipulation," 12th International Symposium of Robotics Research, (accepted).Haptic Virtual Fixtures for Robot-Assisted Manipulation 5. W. R. Chitwood. Robotic Cardiac Surgery. 90th Annual Clinical Congress, American College of Surgeons, New Orleans, Cleveland Clinic Heart Center web page, R.htm

Thank you for your attention!