Robot assisted cardiac tumor rescetion

Robot assisted cardiac tumor resection

By

Sukanta Bhattacharyya

Registration #1651210007

Sunday, April 9, 2023

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Agenda:

Introduction to cardiac MyxomaSymptomsDiagnosis and treatmentTreatment techniques: da Vinci surgical systemSystem designWorkingCase study: resection of left atrial myxomaPros and consConclusion


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Introduction:Cardiac Myxoma(Tumor)

A Myxoma (Greek term muxa meaning mucus) is a tumor of primitive connective tissue cells which form rings, cords that are often associated with capillaries and exist in a myxoid stroma that is composed of variable amounts of proteoglycans, elastin and collagen. It is the most common primary tumor of the heart in adults.


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Area affected: Myxoma is usually located in either the left or right atrium of the heart. According to statistics about 86 percent of Myxoma affects the left atrium of the heart. Myxomas are typically pedunculated, with a stalk that is attached to the interatrial septum. The most common location for attachment of the stalk is the fossa ovalis region of the interatrial septum.


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Fig : Histological image of Myxoma

http://en.wikipedia.org/wiki/File:Atrial_myxoma_high_mag.jpg


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7Fig : Left Atrial Myxoma


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Symptoms:

Constrain in the normal flow of blood in and out of the chambers

FeverWeight lossLoss of consciousnessHemoptysisSudden deathTachycardia (75 - 100 )bpm


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Diagnosis and treatment:Diagnosis

Diagnosis of cardiac myxoma is done by finding by imaging techniques, such as Transthoracic or Trans-esophageal echocardiography(TEE), cardiac magnetic resonance imaging (CMRI) or computed tomography (CT).

Treatment

Best possible treatment for cardiac myxoma is surgery


10Fig: Trans-esophageal echocardiography


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Treatment (surgical techniques):

►Doctor assisted(open heart surgery)►Robot assisted(minimally invasive surgery)


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Robot assisted (minimally invasive surgery)

da Vinci robotic surgical system


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General Introduction

da Vinci surgical system is a robotic surgical system made by the America company Intuitive Surgical Inc. in late 1980s.da Vinci System is called "da Vinci” because Leonardo da Vinci invented the first robot.

It is designed to facilitate complex surgery using a minimally invasive approach, and is controlled by a surgeon from an operating console.


14Fig 3: da Vinci robotic surgical system


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Why da Vinci surgical system?

Minimally invasive tool used to perform surgeriesOnly area of interest is operated Minimizes blood loss and pain and enables quicker

recoveryEliminates natural hand tremor and improves

dexterityBetter accuracyLess operating time


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Incision size comparison


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Types

Fig: da Vinci S Fig: da Vinci Si


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System Design:

da Vinci surgical system is a telemanipulation system consisting of the following components• Surgeon's viewing and control console • Patient-side cart including 4 robotic arms that

position and precisely maneuver • Detachable instruments and an endoscope. • 3-D vision system.


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System Design contd..

Main component Sub parts and functions

Surgeon console Surgeon’s user interface:

• Provide 3 D magnified view of the surgical operating field.

• Surgeon’s thumb and index finger of each hand are placed in adjustable loops.

• 2 finger control actuators mimic the motion of the human hand

• The console contains the hardware and the software of the computer which is essentially equivalent to 5 Pentium 300 processors.


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Surgeon console Foot pedals:

• 1st is the clutch pedal • 2nd is the camera pedal • 3rd is used to focus the telescope lens prior

to surgery.• 4th is used in bipolar coagulation• 5th is used in electro cautery (bi-polar tip,

carries a current that heats and denatures tissue)


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Surgeon console Display system:

• Images of the surgical site are transmitted to the surgeon through a high-resolution stereo display.

• 2 medical grade CRT monitors display one image to each of the surgeon’s eyes.


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Surgeon console Electronic Controller:

• Computer Controller comprises of a closed-loop feedback servo system.

• Mostly velocity controllers (some position controllers )are used with velocity control algorithms.

• Primary module performs control tasks and secondary module has 2-3 filters.

• Redundant sensors, real-time error detection ensures fail-safe operation of the controller in all its states


23Fig: Surgeon console


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Patient side cart Components:

• Robotic cart is 544 kgs approx. and maneuverable on a wheel base

• 3 arms attach to specially designed 8-mm metal ports supplied with both blunt and sharp trocars

• 4th arm has a surgical endoscope.• Fully sterilizable instruments, ranging from

graspers to scalpels having 7 DOF


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Patient side cart Robotic arm/Manipulators:

• Heart of each manipulator is a DC servo motor

• Motors and encoders receive inputs via series of feedback controls from the surgeon.

• Translate them in real-time through the console electronics.

• Provide output signals to the servomotors in the manipulators.

• Manipulators exert forces back through the console electronics to the surgeon’s hands.


26Fig: Robotic arm


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Detachable/ Endo-wrist Instruments

Surgical instruments have a proximal end, a distal end effector suitable for insertion into a patient, and an intermediate part

Tools with 7 degrees of freedom( 3 rotational, 3 translation, 1 grip)

Simulate fine human movementsSurgeons can control the amount of force applied


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Detachable/ Endo-wrist Instruments


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3D vision system

• 3-D endoscope and image processing equipment, provides the real life 3-D images of the operative field

• Two light sources optimize the intensity of light.


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Working of the system: Surgeon is seated at the console with hands in the

masters. The patient-side team is scrubbed and they place

the ports optimally. Endowrist instruments are introduced through the

ports. Movement is by a precise servo-motor

mechanism+ force-feedback sensors+ motion-scaling software, controlled by the computer.


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Working of the system contd..

Computer resolves motions of the surgeon’s arm, from shoulder to hand, into 7 parameters and immediately calculates and reconstructs movements of the robotic arm and attached instruments from these parameters.

A change in a position of an end effector of surgical tool may involve a translation and/or rotation of the end effector from a first location to a second location.

The cancer or tumor is entrapped in a thick plastic bag to avoid any tumor spillage.


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Case study: Resection of Left atrial myxoma

o Proper placement of the robotic arms and specialized equipment on the patient’s body is to reviewed with the operating staff

o Patient is anesthetized and allowed single lung ventilation

o Constant diagnosis by TEE is carried outo After sterile preparation and draping the patient, a

transverse right groin incision is made and femoral artery and vein are dissected and prepared for cannulation


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o da Vinci endoscope is inserted through a 12-15 mm port in the fourth intercostal space (ICS).

o The camera is then introduced through the endoscope port into the pleural space and a small working port is created in the same ICS upward from the camera port

o The surgeon sited at the console begins the operation of the intrathoracic portion by controlling the robotic camera and surgical instrument arms while patient-side assistant changes instruments, supplies and retrieves operative materials.


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o The pericardium is opened and is excisedo Constant monitoring by TEE is performed to spot

the exact location of the myxomao If myxoma is seen on the interatrial septum then a

small incision is made on the septum and thus removed sacrificing a little portion of septum

o If atrial myxoma is located in the right atrium, it can be completely resected from the beating heart

o At last tumor is removed and is extracted using an endopouch bag through the service port without fragmentation in the pleural space.


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Pros Cons

• Minimally invasive technique• Less pain• Less blood loss• Less time required for

operation• Shorter stay of patient in the

hospital• Better result and good

accuracy• Quick recovery

• Cost of maintenance is high• Complex design• Requires large space for

accommodation


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Conclusion:Computer-aided robotic surgical technology is a safe procedure and can be used to perform open-heart procedures such as atrial myxoma excision with a totally endoscopic approach.

Atrial myxoma resection using surgical telemanipulation systems such as the da Vinci surgical system have achieved excellent results and provide an attractive advantage over traditional approaches.


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References:

Robotic Resection of Left Atrial Myxoma-José Francisco Valderrama Marcos,María Teresa González López and Julio Gutiérrez de Loma

Larsson S, Lepore V, Kennergren C. Atrial myxomas: results of 25 years’ experience and review of literature. Surgery 1989;105:695-8

Stajevic MS, Vukomanovic VA, Kuburovic VD, Djuricic SM. Early recurrent left atrial myxoma in a teenager with the novo mutation of Carney complex. Indian J Hum Genet 2011;17:108-10.

Wikipedia-www.wikipedia.com Google search-www.google.com Google images


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THANK YOU

Technology

Robot assisted cardiac tumor rescetion