Endoclamp Balloon Visualization and Automatic Placement System

Authors

  • Hugo Furtado
  • Thomas Stüdeli
  • Mauro Sette
  • Terumasa Morita
  • Primož Trunk
  • Adinda Freudenthal
  • Eigil Samset
  • Jacob Bergsland
  • Borut Geršak

DOI:

https://doi.org/10.1532/HSF98.20091169

Abstract

Objectives: Aortic occlusion is one of the most important open discussions in minimally invasive cardiac surgery. Different techniques can be employed, and all have benefits and drawbacks. The objective of our work is to improve the safety of internal aortic occlusion with the Port Access technique, which employs an endoclamp balloon catheter. We propose a combined information and positioning system based on augmented reality technology and robotics in which the position of the balloon can be seen at all times and can be automatically controlled by a robotic actuator.

Methods: The system was designed by a multidisciplinary team of engineers, medical doctors, and human factor specialists in a human-centered design approach. We measure the balloon position in real time with a magnetic tracking system. This position is superimposed on a 3-dimensional scan of the patient's thorax, with the balloon in the artery shown at all times. The position measurement is also used to control the robotic catheter inserter that places and maintains the balloon position at a specified target. The system was evaluated in 2 user studies that compared it with other visual aids.

Results: The user tests have shown that the system effectively supports the surgeon in the placement task, with an increase in placement accuracy and a reduction in time compared with the current visualization technique. The users also rated the system as supporting them well.

Conclusions: The clinical feasibility of the system was proved. The system provides better visualization and position control and can effectively increase the safety of the procedure. This system has the potential of making Port Access a more attractive technique.

References

Aybek T, Dogan S, Wimmer-Greinecker G, Westphal K, Moritz A. 2000. The micro-mitral operation comparing the Port-Access technique and the transthoracic clamp technique. J Card Surg 15:76-81.nAybek T, Doss M, Abdel-Rahman U, et al. 2005. Echocardiographic assessment in minimally invasive mitral valve surgery. Med Sci Monit 11:MT27-32.nBurfeind WR, Glower DD, Davis RD, Landolfo KP, Lowe JE, Wolfe WG. 2002. Mitral surgery after prior cardiac operation: port-access versus sternotomy or thoracotomy. Ann Thorac Surg 74:S1323-5.nCasselman FP, Van Slycke S, Wellens F, et al. 2003. Mitral valve surgery can now routinely be performed endoscopically. Circulation 108(suppl):II48-54.nChitwood WR Jr, Elbeery JR, Moran JF. 1997. Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg 63:1477-9.nde Cannière D, Dindar M, Stefanidis C, Jegaden O, Jansens JL. 2004. Early experience with a new aortic clamping system designed for port access cardiac surgery: the PortaClamp. Heart Surg Forum 7:E240-4.nDogan S, Aybek T, Risteski PS, et al. 2005. Minimally invasive port access versus conventional mitral valve surgery: prospective randomized study. Ann Thorac Surg 79:492-8.nFarhat F, Metton O, Thivolet F, Jegaden O. 2006. Comparison between 3 aortic clamps for video-assisted cardiac surgery: a histological study in a pig model. Heart Surg Forum 9:E657-60.nGersak B, Sostaric M, Kalisnik JM, Blumauer R. 2005. The preferable use of port access surgical technique for right and left atrial procedures. Heart Surg Forum 8:E354-63.nGersak B, Trobec R, Krisch I, Psenicnik M. 1996. Loss of endothelium-mediated vascular relaxation as a response to various clamping pressures. Eur J Cardiothorac Surg 10:684-9.nGreco E, Barriuso C, Castro MA, Fita G, Pomar JL. 2002. Port-Access cardiac surgery: from a learning process to the standard. Heart Surg Forum 5:145-9.nGrossi E, Ribakove G, Galloway A, et al. 2000. Minimally invasive mitral valve surgery with endovascular balloon technique. Oper Tech Thorac Cardiovasc Surg 5:176-89.nGrossi EA, Galloway AC, LaPietra A, et al. 2002. Minimally invasive mitral valve surgery: a 6-year experience with 714 patients. Ann Thorac Surg 74:660-4.nGrossi EA, Zakow PK, Ribakove G, et al. 1999. Comparison of post-operative pain, stress response, and quality of life in port access vs. standard sternotomy coronary bypass patients. Eur J Cardiothorac Surg 16(suppl 2):S39-42.nGulielmos V, Dangel M, Solowjowa N, et al. 1998. Clinical experiences with minimally invasive mitral valve surgery using a simplified Port Access technique. Eur J Cardiothorac Surg 14:141-7.nHummel J, Figl M, Bax M, Bergmann H, Birkfellner W. 2008. 2D/3D registration of endoscopic ultrasound to CT volume data. Phys Med Biol 53:4303-16.nLinte CA, Wiles AD, Hill N, et al. 2007. An augmented reality environment for image-guidance of off-pump mitral valve implantation. Medical imaging 2007: visualization and image-guided procedures. Proceedings of SPIE 6509. February 18, 2007; San Diego, CA, USA.nModi P, Hassan A, Chitwood WR Jr. 2008. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 34:943-52.nMohr FW, Falk V, Diegeler A, Walther T, van Son JA, Autschbach R. 1998. Minimally invasive port-access mitral valve surgery. J Thorac Cardiovasc Surg 115:567-76.nReichenspurner H, Detter C, Deuse T, Boehm DH, Treede H, Reichart B. 2005. Video and robotic-assisted minimally invasive mitral valve surgery: a comparison of the Port-Access and transthoracic clamp techniques. Ann Thorac Surg 79:485-90.nSchachner T, Bonaros N, Laufer G, Bonatti J. 2004. The ESTECH remote access perfusion cannula in minimally invasive cardiac surgery. Heart Surg Forum 7:E632-5.nSeeburger J, Borger MA, Falk V, et al. 2009. Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients. Ann Thorac Surg 87:709-14.nSoltesz EG, Cohn LH. 2007. Minimally invasive valve surgery. Cardiol Rev 15:109-15.nStüdeli T, Freudenthal A, de Ridder H. 2007. Evaluation framework of ergonomic requirements for iterative design development of computer systems and their user interfaces for minimal invasive therapy. Paper presented at: 8th International Conference on Work with Computing Systems; May 21-24, 1007; Stockholm, Sweden.nWimmer-Greinecker G, Matheis G, Dogan S, et al. 1999. Complications of port-access cardiac surgery. J Card Surg 14:240-5.n

Published

2010-08-18

How to Cite

Furtado, H., Stüdeli, T., Sette, M., Morita, T., Trunk, P., Freudenthal, A., Samset, E., Bergsland, J., & Geršak, B. (2010). Endoclamp Balloon Visualization and Automatic Placement System. The Heart Surgery Forum, 13(4), E205-E211. https://doi.org/10.1532/HSF98.20091169

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