Endoclamp balloon visualization and automatic placement system.
OBJECTIVE
Aortic occlusion is one of the most important open discussions in minimally invasive cardiac surgery. Different techniques can be employed, and all have benefits and drawbacks. The objective of our work is to improve the safety of internal aortic occlusion with the Port Access technique, which employs an endoclamp balloon catheter. We propose a combined information and positioning system based on augmented reality technology and robotics in which the position of the balloon can be seen at all times and can be automatically controlled by a robotic actuator.


METHODS
The system was designed by a multidisciplinary team of engineers, medical doctors, and human factor specialists in a human-centered design approach. We measure the balloon position in real time with a magnetic tracking system. This position is superimposed on a 3-dimensional scan of the patient's thorax, with the balloon in the artery shown at all times. The position measurement is also used to control the robotic catheter inserter that places and maintains the balloon position at a specified target. The system was evaluated in 2 user studies that compared it with other visual aids.


RESULTS
The user tests have shown that the system effectively supports the surgeon in the placement task, with an increase in placement accuracy and a reduction in time compared with the current visualization technique. The users also rated the system as supporting them well.


CONCLUSIONS
The clinical feasibility of the system was proved. The system provides better visualization and position control and can effectively increase the safety of the procedure. This system has the potential of making Port Access a more attractive technique.
Furtado
Hugo
H
Department of Cardiovascular Surgery, University Medical Centre, Ljubljana, Slovenia. hugo.furtado@meduniwien.ac.at
Stüdeli
Thomas
T
Sette
Mauro
M
Morita
Terumasa
T
Trunk
Primoz
P
Freudenthal
Adinda
A
Samset
Eigil
E
Bergsland
Jacob
J
Gersak
Borut
B
D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001331:Automation; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation*; D002408:Catheters, Indwelling; D003199:Computer Systems; D003250:Constriction; D004867:Equipment Design; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery; D012371:Robotics