Robot assisted cardiac tumor rescetion

Robot assisted cardiac tumor resection
By
Sukanta Bhattacharyya
Registration #1651210007

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

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

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

Fig : Histological image of Myxoma
5

Fig : Left Atrial Myxoma
7

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

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
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Fig: Trans-esophageal echocardiography
10

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
12

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.
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Fig 3: da Vinci robotic surgical system
14

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

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.
19

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

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

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
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Fig: 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.
25

Fig: Robotic arm 26

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

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.
29

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

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

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
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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.
34

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

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
39

Robot assisted cardiac tumor rescetion

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