Model-Guided Epicardial Interventions using a Novel “Snake” Robot (Cardio-Arm) through a Subxiphoid Port Access

Abstract

We have developed a novel highly-articulated "snake" robot (CardioARM) for minimally invasive single-port cardiac interventions. In a porcine preparation (N=5), we tested the hypothesis that intrapericardial navigation and epicardial ablation is feasible and safe using a model-guided approach for path-planning and therapeutic delivery. Pre-procedure, high-resolution, computerized chest tomography angiograms (CTA) were reconstructed in 3-D to create a model of the heart and surrounding mediastinal structures. In the operating room, the 3-D CTA model was registered using fiducials with a commercially available tracking system (Aurora, NDI). A sensor was introduced through one of the working ports of the CardioARM and positioned at its tip. Six epicardial targets were chosen and the CardioARM was navigated by the operator, using a master manipulator, solely based on model-guidance. Once each target acquisition was confirmed by anatomical guidance, radiofrequency ablation was performed. All targets were successfully acquired and ablation was performed without complications. We conclude that the CardioARM can be used safely to perform single-port minimally invasive model-guided interventions on the beating heart in an experimental porcine preparation. Further studies, including autonomous target acquisition, are warranted.