Journal
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING
Volume 68, Issue 4, Pages 1238-1249Publisher
IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC
DOI: 10.1109/TBME.2020.3024184
Keywords
Valves; Manipulators; Heart; Diseases; Minimally invasive surgery; Aortic valve surgery; minimally invasive surgery (MIS); robotic surgical endoscopy; sutureless aortic valves; surgical flexible manipulator
Categories
Funding
- Regione Toscana, Bando Fas Salute 2014, ValveTech project
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The ValveTech robot, equipped with a flexible manipulator, was successful in delivering artificial valves to the desired position. Evaluations by ten cardiac surgeons demonstrated faster delivery and revealed certain measurement errors in positioning during the trials.
Objective: Aortic valve disease is the most common heart disease in the elderly calling for replacement with an artificial valve. The presented surgical robot aims to provide a highly controllable instrument for efficient delivery of an artificial valve by the help of integrated endoscopic vision. Methods: A robot (called ValveTech), intended for minimally invasive surgery (MIS) and consisting of a flexible cable driven manipulator, a passive arm, and a control unit has been designed and prototyped. The flexible manipulator has several features (e.g., stabilizing flaps, tiny cameras, dexterous introducer and custom cartridge) to help the proper valve placement. It provides 5 degrees of freedom for reaching the operative site via mini-thoracotomy; it adjusts the valve and expands it at the optimal position. The robot was evaluated by ten cardiac surgeons following a real surgical scenario in artificial chest simulator with an aortic mockup. Moreover, after each delivery, the expanded valve was evaluated objectively in comparison with the ideal position. Results: The robot performances were evaluated positively by surgeons. The trials resulted in faster delivery and an average misalignment distance of 3.8 mm along the aorta axis; 16.3 degrees rotational angle around aorta axis and 8.8 degrees misalignment of the valve commissure plane to the ideal plane were measured. Conclusion: The trials successfully proved the proposed system for valve delivery under endoscopic vision. Significance: The ValveTech robot can be an alternative solution for minimally invasive aortic valve surgery and improve the quality of the operation both for surgeons and patients.
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