Cardiac Patch Transplantation Instruments for Robotic Minimally Invasive Cardiac Surgery: Initial Proof-of-concept Designs and Surgery in a Porcine Cadaver.

Christopher D Roche,Anthony Dome,Minh H Nguyen,Sohaima Mabroora,Kareem Sakr,Gautam R Iyer,Rohan Pawar,Carmine Gentile,Christopher C Wilson,Vincent Lee

doi:10.3389/frobt.2021.714356

Abstract

Background: Damaged cardiac tissues could potentially be regenerated by transplanting bioengineered cardiac patches to the heart surface. To be fully paradigm-shifting, such patches may need to be transplanted using minimally invasive robotic cardiac surgery (not only traditional open surgery). Here, we present novel robotic designs, initial prototyping and a new surgical operation for instruments to transplant patches via robotic minimally invasive heart surgery. Methods: Robotic surgical instruments and automated control systems were designed, tested with simulation software and prototyped. Surgical proof-of-concept testing was performed on a pig cadaver. Results: Three robotic instrument designs were developed. The first (called “Claw” for the claw-like patch holder at the tip) operates on a rack and pinion mechanism. The second design (“Shell-Beak”) uses adjustable folding plates and rods with a bevel gear mechanism. The third (“HeartStamp”) utilizes a stamp platform protruding through an adjustable ring. For the HeartStamp, rods run through a cylindrical structure designed to fit a uniportal Video-Assisted Thorascopic Surgery (VATS) surgical port. Designed to work with or without a sterile sheath, the patch is pushed out by the stamp platform as it protrudes. Two instrument robotic control systems were designed, simulated in silico and one of these underwent early ‘sizing and learning’ prototyping as a proof-of-concept. To reflect real surgical conditions, surgery was run “live” and reported exactly (as-it-happened). We successfully picked up, transferred and released a patch onto the heart using the HeartStamp in a pig cadaver model. Conclusion: These world-first designs, early prototypes and a novel surgical operation pave the way for robotic instruments for automated keyhole patch transplantation to the heart. Our novel approach is presented for others to build upon free from restrictions or cost—potentially a significant moment in myocardial regeneration surgery which may open a therapeutic avenue for patients unfit for traditional open surgery.

Highlights

Advances in regenerative medicine have raised the hope of restoring damaged heart muscle (Roche et al, 2020)
We present world-first cardiac patch transplantation instrument designs, with simulated robotic control systems, along with initial prototyping and a proof-ofconcept surgical test in a pig cadaver
The plate holder was designed with a diameter of 9.80 mm considering the keyhole surgery incision (Supplementary Figure S4)

Summary

Introduction

Advances in regenerative medicine have raised the hope of restoring damaged heart muscle (Roche et al, 2020). Until recently (Roche et al, 2021b; Wang et al, 2021), open surgical approaches have been investigated (Wang et al, 2020), even though this could exclude heart failure patients unfit for the physiological demands of open chest surgery (but who might be fit enough to undergo a less invasive procedure). If patch-based myocardial repair is to realize its paradigm-shifting therapeutic potential (for example, as a standalone procedure and/or an adjunct for a patient already undergoing surgery for some other reason), it should be compatible with minimally invasive (keyhole) robotic surgical approaches (Roche et al, 2021b). Damaged cardiac tissues could potentially be regenerated by transplanting bioengineered cardiac patches to the heart surface. We present novel robotic designs, initial prototyping and a new surgical operation for instruments to transplant patches via robotic minimally invasive heart surgery

Methods

Results

Discussion

Conclusion