Robot assisted cardiac tumor rescetion


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Describes in details about the robotic surgery of cardiac tumor

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Robot assisted cardiac tumor rescetion

  1. 1. Robot assisted cardiac tumor resection By Sukanta Bhattacharyya Registration #1651210007
  2. 2. Agenda: Introduction to cardiac Myxoma Symptoms Diagnosis and treatment Treatment techniques: da Vinci surgical system System design Working Case study: resection of left atrial myxoma Pros and cons Conclusion 2 Thursday, October 03, 2013
  3. 3. 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. 3 Thursday, October 03, 2013
  4. 4. 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. 4 Thursday, October 03, 2013
  5. 5. Fig : Histological image of Myxoma 5 Thursday, October 03, 2013
  6. 6. 6 Thursday, October 03, 2013
  7. 7. Fig : Left Atrial Myxoma 7 Thursday, October 03, 2013
  8. 8. Symptoms: Constrain in the normal flow of blood in and out of the chambers Fever Weight loss Loss of consciousness Hemoptysis Sudden death Tachycardia (75 - 100 )bpm 8 Thursday, October 03, 2013
  9. 9. 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 9 Thursday, October 03, 2013
  10. 10. Fig: Trans-esophageal echocardiography 10 Thursday, October 03, 2013
  11. 11. Treatment (surgical techniques): ►Doctor assisted(open heart surgery) ►Robot assisted(minimally invasive surgery) 11 Thursday, October 03, 2013
  12. 12. Robot assisted (minimally invasive surgery) da Vinci robotic surgical system 12 Thursday, October 03, 2013
  13. 13. 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. 13 Thursday, October 03, 2013
  14. 14. Fig 3: da Vinci robotic surgical system 14 Thursday, October 03, 2013
  15. 15. Why da Vinci surgical system? Minimally invasive tool used to perform surgeries Only area of interest is operated Minimizes blood loss and pain and enables quicker recovery Eliminates natural hand tremor and improves dexterity Better accuracy Less operating time 15 Thursday, October 03, 2013
  16. 16. Incision size comparison 16 Thursday, October 03, 2013
  17. 17. Types Fig: da Vinci S Fig: da Vinci Si 17 Thursday, October 03, 2013
  18. 18. 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. 18 Thursday, October 03, 2013
  19. 19. 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. 19 Thursday, October 03, 2013
  20. 20. System Design contd.. Main component Sub parts and functions 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) 20 Thursday, October 03, 2013
  21. 21. System Design contd.. Main component Sub parts and functions 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. 21 Thursday, October 03, 2013
  22. 22. System Design contd.. Main component Sub parts and functions 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 22 Thursday, October 03, 2013
  23. 23. Fig: Surgeon console 23 Thursday, October 03, 2013
  24. 24. System Design contd.. Main component Sub parts and functions 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 24 Thursday, October 03, 2013
  25. 25. System Design contd.. Main component Sub parts and functions 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. 25 Thursday, October 03, 2013
  26. 26. Fig: Robotic arm 26 Thursday, October 03, 2013
  27. 27. 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 movements Surgeons can control the amount of force applied 27 Thursday, October 03, 2013
  28. 28. Detachable/ Endo-wrist Instruments 28 Thursday, October 03, 2013
  29. 29. 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. 29 Thursday, October 03, 2013
  30. 30. 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. 30 Thursday, October 03, 2013
  31. 31. 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. 31 Thursday, October 03, 2013
  32. 32. 32 Thursday, October 03, 2013
  33. 33. 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 out o 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 33 Thursday, October 03, 2013
  34. 34. 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. 34 Thursday, October 03, 2013
  35. 35. o The pericardium is opened and is excised o Constant monitoring by TEE is performed to spot the exact location of the myxoma o 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. 35 Thursday, October 03, 2013
  36. 36. 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 36 Thursday, October 03, 2013
  37. 37. 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. 37 Thursday, October 03, 2013
  38. 38. 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.   Google  Google images 38 Thursday, October 03, 2013
  39. 39. THANK YOU 39 Thursday, October 03, 2013