Pneumatic Actuated Robotic Assistant System for Aortic Valve Replacement Under MRI Guidance

National Institutes of Health, Bethesda, MD 20892, USA.
IEEE transactions on bio-medical engineering (Impact Factor: 2.35). 10/2010; 58(2):443-51. DOI: 10.1109/TBME.2010.2089983
Source: PubMed


We present a pneumatic actuated robotic assistant system for transapical aortic valve replacement under MRI guidance in a beating heart. This is a minimally invasive procedure that is currently performed manually inside the MRI bore. A robotic assistance system that integrates an interactive real-time MRI system, a robotic arm with a newly developed robotic valve delivery module, as well as user interfaces for the physician to plan the procedure and manipulate the robot, would be advantageous for the procedure. An Innomotion arm with hands-on cooperative interface was used as a device holder. A compact MRI compatible robotic delivery module was developed for delivering both balloon-expandable and self-expanding prostheses. A compact fiducial that can be placed close to the volume of interest and requires a single image plane was used for image-based robot registration. The system provides different user interfaces at various stages of the procedure. We present the development and evaluation of the components and the system in ex-vivo experiments.

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Available from: Keith A Horvath,
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    • "However, neither of these systems have demonstrated applicability for TAVI-related procedures. Li et al. described a robotic system capable of TA-TAVI under magnetic resonance imaging (MRI) [13], [14]. But MR-imaging does not allow visualization of the existing catheters used in TAVI-related procedures without the use of markers. "
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    ABSTRACT: Recent technological advancements in cardiovas-cular surgery such as transapical transcatheter aortic valve implantation (TA-TAVI) enabled treatment to elderly that were initially declined surgery. However, valve malpositioning during TA-TAVI have been reported in several cases. In this preliminary study, we present a novel approach in which a Robotically-Actuated Delivery Sheath (RADS) is used to potentially facilitate valve positioning. A model is developed that describes the shape and articulating tip position of the RADS. We developed a two-dimensional ultrasound tracking method that evaluates the tip position of the RADS in ultrasound images. Both modeling and ultrasound tracking are combined into an integrated system that facilitates closed-loop control of the articulating tip of the RADS. Experiments are performed in order to evaluate the tracking accuracy of the RADS. Experiments show mean positioning errors of approximately 2 mm along the x-and y-axes. Our study demonstrates that the RADS can potentially provide compensation for beating heart and respiratory motions during valve positioning and deployment in TA-TAVI.
    2014 IEEE International Conference on Robotics & Automation (ICRA); 06/2014
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    • "Based on the results seen with a surgeon and human assistant manual approach, we developed an MRI compatible robotic surgical assistant system that could more precisely deliver aortic valve prostheses [29–32]. The robotic system consists of an MRI compatible robotic arm, a valve delivery module, and user interfaces for the surgeon to plan the procedure and manipulate the robot. "
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    ABSTRACT: Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models.
    Minimally Invasive Surgery 10/2012; 2012(6):145381. DOI:10.1155/2012/145381
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    • "Robotic systems have been developed for the TAVI using intraoperative MRI guidance (Li et al., 2008, 2011). Real-time 3D transesophageal (TEE) is recently presented for guiding the TAVI (Siegel et al., 2011). "

    Aortic Valve, 12/2011; , ISBN: 978-953-307-561-7
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