Computer-guided pericardiocentesis: experimental results and clinical perspectives.
Percutaneous pericardial puncture is a relatively safe and effective technique in case of large pericardial effusions when practiced under echographic or radiological control. The goal of our project is to improve the performance of this technique, mainly in case of smaller and loculated effusions using an accurate guidance towards a preplanned target, based on a model of the pericardial effusion. This paper presents preclinical results of this new computer-assisted technique used to reach the pericardial cavity. The procedure is divided into 3 steps: 1. acquisition of ultrasound data, using an echocardiographic device connected to a 3-D localizer and to a computer, 2. modeling procedure to define the optimal strategy taking into account the mobility of organs on a digital model, 3. guided puncture with a localized needle to reach the predefined target using a passive guidance system. After validation on a dynamic phantom and a feasibility study on dogs, an accuracy and reliability analysis protocol was realized on pigs with experimental pericardial effusion. Feasibility of the technique is demonstrated on animal study with an accuracy of at least 2.5 mm. Further clinical investigation is in progress using a more ergonomic and less cumbersome system. This study demonstrates the feasibility of computer-assisted pericardiocentesis. Beyond the simple improvement of the current technique, this could be a new way to reach the heart or a new tool for percutaneous access and image-guided puncture of soft tissues.
Chavanon
O
O
Department of Cardiac Surgery, Grenoble University Hospital, Grenoble, France. olivier.chavanon@wanadoo.fr
Carrat
L
L
Pasqualini
C
C
Dubois
E
E
Blin
D
D
Troccaz
J
J
D000818:Animals; D001185:Artificial Intelligence; D004452:Echocardiography / Q000295:instrumentation*; D005103:Expert Systems; D005240:Feasibility Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D021621:Imaging, Three-Dimensional; D008838:Microcomputers; D020519:Pericardiocentesis / Q000295:instrumentation*; D019047:Phantoms, Imaging; D013552:Swine; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D014584:User-Computer Interface