A World-First Surgical Instrument for Minimally Invasive Robotically-Enabled Transplantation of Heart Patches for Myocardial Regeneration: A Brief Research Report.

Christopher David Roche,Liang Zhao,Carmine Gentile,Yiran Zhou

doi:10.3389/fsurg.2021.653328

Abstract

Background: Patch-based approaches to regenerating damaged myocardium include epicardial surgical transplantation of heart patches. By the time this therapy is ready for widespread clinical use, it may be important that patches can be delivered via minimally invasive and robotic surgical approaches. This brief research report describes a world-first minimally invasive patch transplantation surgical device design enabled for human operation, master-slave, and fully automated robotic control.Method: Over a 12-month period (2019–20) in our multidisciplinary team we designed a surgical instrument to transplant heart patches to the epicardial surface. The device was designed for use via uni-portal or multi-portal Video-Assisted Thorascopic Surgery (VATS). For preliminary feasibility and sizing, we used a 3D printer to produce parts of a flexible resin model from a computer-aided design (CAD) software platform in preparation for more robust high-resolution metal manufacturing.Results: The instrument was designed as a sheath containing foldable arms, <2 cm in diameter when infolded to fit minimally invasive thoracic ports. The total length was 35 cm. When the arms were projected from the sheath, three moveable mechanical arms at the distal end were designed to hold a patch. Features included: a rotational head allowing for the arms to be angled in real time, a surface with micro-attachment points for patches and a releasing mechanism to release the patch.Conclusion: This brief research report represents a first step on a potential pathway towards minimally invasive robotic epicardial patch transplantation. For full feasibility testing, future proof-of-concept studies, and efficacy trials will be needed.

Highlights

Since the first reports of robotic minimally invasive cardiac surgery [1], there has been increasing attention given to the role of minimally invasive robotics in cardiothoracic surgery [2,3,4,5,6]
This brief research report represents a first step on a potential pathway towards minimally invasive robotic epicardial patch transplantation
An initial outline of the design was sketched with attention to the ergonomics at human surgery, the size and material requirements for thorascopic insertion and manipulation of the instrument within the chest cavity, the shape requirements to ensure suitability for human cardiothoracic anatomy, the mechanism to allow for an operator to manoeuvre the instrument using handles outside the chest cavity at the proximal end of the instrument and the ability for the device to be controlled in future by both master-slave robotics and fully automated robotics

Summary

Introduction

Since the first reports of robotic minimally invasive cardiac surgery [1], there has been increasing attention given to the role of minimally invasive robotics in cardiothoracic surgery [2,3,4,5,6]. There is an unanswered but pressing question whether surgical patch-based repair of the heart will need to be delivered by minimally invasive and/or robotic surgery by the time it reaches widespread clinical use [7]. Patch-based approaches to regenerating damaged myocardium include epicardial surgical transplantation of heart patches By the time this therapy is ready for widespread clinical use, it may be important that patches can be delivered via minimally invasive and robotic surgical approaches. This brief research report describes a world-first minimally invasive patch transplantation surgical device design enabled for human operation, master-slave, and fully automated robotic control

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Conclusion