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The "HeartLander" Robot
There are several major risks inherent in cardiac surgery. One is the
need to perform delicate operations on a flexible organ that is in constant
motion. Another is the requirement for general anaesthesia. Open-heart
surgery, involving "cracking the chest," is about as invasive
as a medical procedure can get. Even the newer minimally invasive procedures
require deflating a lung. A technology that eliminates these risks would
offer a giant step forward in cardiac surgery.
The NSF-funded Engineering Research Center (ERC) for Computer-Integrated
Surgical Systems and Technology (CISST) is headquartered at Johns Hopkins
University, with partners at three hospitals and two other universities,
Carnegie Mellon University (CMU) and MIT. The aim of this research center
is to develop new computing methods, surgical systems, and technological
aids that can revolutionize surgical procedures. As one powerful example,
over the past few years the CISST's Dr. Cam Riviere and his colleagues
at CMU have developed HeartLander, a small, minimally invasive robot that
can move along the surface of the heart and navigate to any desired work
site under the control of a surgeon, who uses it to perform surgery.
Here's how it works: Using suction to adhere to the beating heart, the
HeartLander crawls like an inchworm across the surface, just beneath the
enveloping pericardium. (This autonomous movement is an important advance
over existing cardiac surgical aids that are manipulated at the end of
a stiff wand.) The device incorporates a videoscope to provide visual
feedback to the surgeon, who controls it through a joystick interface.
The 8mm-diameter device has a flexible working channel through which various
tools can be introduced for such surgical procedures as electrode placement,
tissue ablation, drug or tissue injection, and anastomosis.
Because the HeartLander attaches directly to the surface of the heart,
it can be used to perform high-precision procedures without compensating
for the heartbeat motion. Since it can crawl or walk to any point on the
heart's surface from an incision made anywhere in the pericardial sac,
it can be inserted through an entry point below the ribcage and does not
require general anesthesia or deflation of the left lung, as typical minimally
invasive heart surgery instruments do. Because the HeartLander requires
only local or regional anesthesia, it could for the first time enable
ambulatory outpatient heart surgery. Another important advantage is that
the device potentially solves the problem of access to the back of the
heart.
The HeartLander prototype was tested initially on the beating hearts of
four live pigs, with open chest, where it demonstrated successful attachment,
turning, and "walking." In early 2006, for the first time the
device was demonstrated on a closed-chest beating pig heart-a typical
simulation of surgery on a living human heart. A patent has been filed
for the device. Meanwhile, a start-up company, Enhanced Medical Systems
LLC, has been established to commercialize it. Led by mechanical/biomedical
engineer Dr. Dwight Meglan, the company is currently in discussions with
medical device manufacturers as potential partners, selecting clinical
targets, and continuing with development of this revolutionary new device.
To learn more about this topic:
Visit the Heartlander Web site at http://www.cs.cmu.edu/~heartlander/design.html.
Videos of the robot in action are at http://www.cs.cmu.edu/~heartlander/videos.html
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