Automated Knot Tying For Fixation in Minimally Invasive, Robot-Assisted Cardiac Surgery

[+] Author and Article Information
J. F. Kuniholm, G. D. Buckner

Department of Mechanical and Aerospace Engineering,  North Carolina State University, Raleigh, NC 27695

W. Nifong

Brody School of Medicine,  East Carolina University, Greenville, NC 27834

M. Orrico

 Cardio Vations, Inc., Somerville, NJ 08876

J Biomech Eng 127(6), 1001-1008 (Aug 12, 2005) (8 pages) doi:10.1115/1.2055307 History: Received April 08, 2005; Revised August 12, 2005

Cardiovascular disease (CVD) is perhaps the most significant worldwide health issue. While open-heart surgery remains the predominant treatment, significant advancements have been made in minimally invasive surgery (MIS) and minimally invasive robot-assisted (MIRA) surgery. MIRA techniques offer many advantages over open-heart procedures and have extended the capabilities of MIS. However, these benefits come at the cost of increased operating times due to time spent tying knots. The additional bypass time limits patient access and is the most significant barrier to the adoption of MIRA techniques. This research seeks to overcome this barrier by designing a device for MIRA cardiac procedures that automates the knotting of sutures. If this task can be automated while ensuring the delivery of high-quality knots, great progress can be made in transforming the field. MIRA cardiac procedures can move from novel procedures performed by a select group of surgeons on a limited pool of patients to a viable alternative available to the majority of patients with CVD. In this research we propose a design for a self-contained device that delivers a locking knot. Results suggest that consistent knots can be delivered at a time savings of 12.5% and 26.4% over manual knots for trained and untrained users of a surgical robot, respectively.

Copyright © 2005 by American Society of Mechanical Engineers
Topics: Surgery , Robots
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Figure 1

Median sternotomy used in traditional open heart surgery (Ref. 18)

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Figure 2

Minimally invasive cardiac surgery is performed through a variety of small incisions (Ref. 19)

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Figure 3

A minithoracotomy used for minimally invasive surgery (Ref. 20)

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Figure 4

Endoscopic surgical instruments (Ref. 4)

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Figure 5

The da Vinci™ surgical robot from Intuitive Surgical (Ref. 21)

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Figure 6

Suturing during MV repair using the da Vinci™ robotic surgical system (Ref. 6)

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Figure 7

Section view of MIRA MV repair setup showing minithoracotomy, robot arm ports, and atrial retractor (Ref. 22)

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Figure 8

Annular mitral valve prosthesis (Ref. 15)

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Figure 9

The surgeon’s knot: six overhand knot throws with on extra twist in the initial throw

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Figure 10

LSI Solutions' Ti-Knot™ titanium suture crimp (Ref. 23)

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Figure 11

Coalescent Surgical’s nitinol U-clips™, before and after deployment (Ref. 24)

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Figure 12

Quik-Stitch™ system by Pare Surgical, Inc. (Ref. 25)

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Figure 13

Ethicon Endosurgery, Inc.’s Suture Assistant™ endoscopic suturing device in use (Ref. 26)

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Figure 14

Sequence 1: suture cartridge delivered to surgeon, needle removed from cartridge

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Figure 15

Sequence 2: needle passed through tissue, then through loop of pretied knot, and secured

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Figure 16

Sequence 3: with suture secured in the device and needle returned, surgeon actuates the knot

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Figure 17

Duraknot™ assembly prior to deployment (Ref. 27)

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Figure 18

CAD-generated views of the final Suture Cartridge prototype

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Figure 19

Final Suture Cartridge prototype

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Figure 20

Robotic manipulators deploy a Duraknot™ into a silicon heart model using the Suture Cartridge




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