Performing cardiac surgery without cardioplegia

Abstract

Systems and methods are provided for performing a surgical procedure on a beating heart of a patient. Methods are provided which include positioning an end effector in close proximity to a surgical site on the heart, the end effector being mounted on a robotically controlled arm. The motion of the surgical site is monitored and end effector tracking command signals computed in response to the monitored motion of the surgical site. The tracking command signals are forwarded to actuators operatively associated with the robotically controlled arm to cause the arm to move the end effector generally to track motion of the surgical site. The method further includes inputting an end effector movement command signal, and forwarding the end effector movement command signal to the actuators to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure.

1 . A method of performing a surgical procedure on a beating heart of a patient, the method including: 
 positioning an end effector in close proximity to a surgical site on the heart, at which site the surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;    bracing the beating heart to at least reduce motion of the surgical site;    monitoring motion of the surgical site;    computing end effector tracking command signals in response to monitored motion of the surgical site;    forwarding the tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the end effector generally to track motion of the surgical site;    inputting an end effector movement command signal; and    forwarding the end effector movement command signal to the actuators to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site.    
     
     
         2 . A method as claimed in  claim 1 , in which bracing the beating heart includes contacting the heart with a brace member connected to a stationary base positioned outside the patient.  
     
     
         3 . A method as claimed in  claim 2 , in which the brace member is arranged to operate under suction, the method including displacing air relative to the brace member to cause the brace member to attach itself to the heart by suction.  
     
     
         4 . A method as claimed in  claim 2 , in which the brace member is connected to the base by means of a robotically controlled arm, the method including forwarding command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the brace member from a position clear of the heart to a position in contact with the heart.  
     
     
         5 . A method as claimed in  claim 2 , which includes maintaining the brace member in a stationary condition relative to the base when in contact with the beating heart so as to inhibit heart motion by at least one degree of freedom of movement.  
     
     
         6 . A method as claimed in  claim 2 , which includes permitting the brace member to move in sympathy with the heart and whilst in contact therewith, restraining motion of the brace member so as to restrain motion of the surgical site, monitoring motion of the surgical site then including monitoring restrained motion of the brace member.  
     
     
         7 . A method as claimed in  claim 1 , in which monitoring motion of the surgical site includes contacting the surgical site with a motion detector, permitting the motion detector to move in sympathy with the surgical site and monitoring movement of the motion detector so as to monitor motion of the surgical site.  
     
     
         8 . A method as claimed in  claim 1 , in which monitoring motion of the surgical site includes securing at least one target marker on the surgical site and monitoring movement of the target marker so as to monitor motion of the surgical site.  
     
     
         9 . A method as claimed in  claim 8 , which includes securing a plurality of target markers at spaced apart positions on the surgical site and monitoring movement of the target markers so as to monitor motion of the surgical site.  
     
     
         10 . A method as claimed in  claim 9 , in which the movement of the target markers differ, monitoring motion of the surgical site then including monitoring a computed motion derived from the motions of at least some of the target markers.  
     
     
         11 . A method as claimed in  claim 9 , in which the target markers are arranged to cooperate with a sensor, the method further comprising positioning a sensor at an appropriate position to detect motion of the target markers.  
     
     
         12 . A method as claimed in  claim 11 , in which the sensor is arranged to cooperate with the markers so as to monitor their movements electromagnetically.  
     
     
         13 . A method as claimed in  claim 1 , which further includes: 
 directing an image capture device at the surgical site to capture an image of the surgical site;    displaying the image of the surgical site on an image display operatively connected to the image capture device; and    compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.    
     
     
         14 . A method as claimed in  claim 13 , wherein the image capture device is mounted on a robotically controlled arm, compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device comprising: 
 computing image capture device tracking command signals in response to monitored motion of the surgical site; and    forwarding the image capture device tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the image capture device generally to track motion of the surgical site.    
     
     
         15 . A method as claimed in  claim 13 , wherein the image capture device is arranged to capture at least two images of the surgical site from two different vantage points, compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device comprising processing information related to the two images so as to cause the image of the surgical site displayed on the image display to be displayed as if the surgical site were generally stationary relative to the image capture device.  
     
     
         16 . A method as claimed in  claim 15 , in which processing the information related to the two images comprises transforming optical information related to the two images into digital information and processing the digital information so as to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.  
     
     
         17 . A method as claimed in  claim 15 , in which monitoring motion of the surgical site includes the processing of the information related to the two images.  
     
     
         18 . A method as claimed in  claim 17 , in which computing the tracking command signals in response to the monitored motion of the surgical site includes computing tracking command signals in the form of vectors derived from information corresponding to the two images.  
     
     
         19 . A method as claimed in  claim 18 , in which processing the information related to the two images includes defining a plurality of discrete locations at the surgical site and monitoring the motion of the discrete locations by means of information derived from the two images.  
     
     
         20 . A method as claimed in  claim 19 , which includes securing markers on the surgical site at the discrete locations.  
     
     
         21 . A method as claimed in  claim 20 , in which the markers are distinctively colored, monitoring the motion of the discrete locations then including monitoring motion of the distinctively colored markers.  
     
     
         22 . A method as claimed in  claim 13 , in which the image capture device is in the form of a stereo endoscope, directing the image capture device at the surgical site then including passing a viewing end of the endoscope through a relatively small aperture in a chest region of a patient.  
     
     
         23 . A method as claimed in  claim 1  or  claim 13 , which includes analyzing information corresponding to monitored motion history of the surgical site to predict motion of the surgical site.  
     
     
         24 . A method as claimed in  claim 23 , in which computing tracking command signals in response to monitored motion of the surgical site includes computing the tracking command signals from predicted motion of the surgical site.  
     
     
         25 . A method as claimed in  claim 23 , in which predicting motion of the surgical site includes comparing information corresponding to monitored motion of the surgical site with an ECG signal.  
     
     
         26 . A method as claimed in  claim 1 , in which the surgical procedure is to be performed in a minimally invasive manner, positioning the end effector in close proximity to the surgical site on the heart then including passing the end effector through a relatively small aperture in a chest region of the patient. A method as claimed in  claim 1 , in which the surgical procedure is to be performed in a minimally invasive manner, positioning the end effector in close proximity to the surgical site on the heart then including passing the end effector through a relatively small aperture in a chest region of the patient.  
     
     
         27 . A method of performing a surgical procedure on a beating heart of a patient, the method including: 
 positioning an end effector in close proximity to a surgical site on the heart, at which site the surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;    monitoring motion of the surgical site;    computing end effector tracking command signals in response to monitored motion of the surgical site;    forwarding the tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the end effector generally to track motion of the surgical site;    inputting an end effector movement command signal;    forwarding the end effector movement command signal to the actuators to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site;    directing an image capture device at the surgical site to capture at least one image of the surgical site; and    processing information related to the at least one image to create in an image of the surgical site which appears as though the surgical site were generally stationary relative to the image capture device.    
     
     
         28 . A method as claimed in  claim 27 , which further includes bracing the beating heart to at least reduce motion of the surgical site.  
     
     
         29 . A method as claimed in  claim 28 , in which bracing the beating heart includes contacting the heart with a brace member connected to a stationary base positioned outside the patient.  
     
     
         30 . A method as claimed in  claim 29 , in which the brace member is arranged to operate under suction, the method including displacing air relative to the brace member to cause the brace member to attach itself to the heart by suction.  
     
     
         31 . A method as claimed in  claim 29 , in which the brace member is connected to the base by means of a robotically controlled arm, the method including forwarding command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the brace member from a position clear of the heart to a position in contact with the heart.  
     
     
         32 . A method as claimed in  claim 29 , which includes maintaining the brace member in a stationary condition relative to the base when in contact with the beating heart so as to inhibit heart motion by at least one degree of freedom of movement.  
     
     
         33 . A method as claimed in  claim 29 , which includes permitting the brace member to move in sympathy with the heart and whilst in contact therewith, restraining motion of the brace member so as to restrain motion of the surgical site, monitoring motion of the surgical site then including monitoring restrained motion of the brace member.  
     
     
         34 . A method as claimed in  claim 27 , in which monitoring motion of the surgical site includes contacting the surgical site with a motion detector, permitting the motion detector to move in sympathy with the surgical site and monitoring movement of the motion detector so as to monitor motion of the surgical site.  
     
     
         35 . A method as claimed in  claim 27 , in which monitoring motion of the surgical site includes securing at least one target marker on the surgical site and monitoring movement of the target marker so as to monitor motion of the surgical site.  
     
     
         36 . A method as claimed in  claim 35 , which includes securing a plurality of target markers at spaced apart positions on the surgical site and monitoring movement of the target markers so as to monitor motion of the surgical site.  
     
     
         37 . A method as claimed in  claim 36 , in which the movement of the target markers differ, monitoring motion of the surgical site then including monitoring a computed motion derived from the motions of at least some of the target markers.  
     
     
         38 . A method as claimed in  claim 36 , in which the target markers are arranged to cooperate with a sensor, the method further comprising positioning a sensor at an appropriate position to detect motion of the target markers.  
     
     
         39 . A method as claimed in  claim 38 , in which the sensor is arranged to cooperate with the markers so as to monitor their movements electromagnetically.  
     
     
         40 . A method as claimed in  claim 27 , which further includes displaying the image of the surgical site on an image display operatively connected to the image capture device.  
     
     
         41 . A method as claimed in  claim 40 , wherein the at least one image comprises at least two images of the surgical site captured from two different vantage points.  
     
     
         42 . A method as claimed in  claim 41 , in which processing the information related to the at least two images comprises transforming optical information related to the at least two images into digital information and processing the digital information so as to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.  
     
     
         43 . A method as claimed in  claim 41 , in which computing the tracking command signals in response to the monitored motion of the surgical site includes computing tracking command signals in the form of vectors derived from information corresponding to the at least two images.  
     
     
         44 . A method as claimed in  claim 43 , in which processing the information related to the at least two images includes defining a plurality of discrete locations at the surgical site and monitoring the motion of the discrete locations by means of information derived from the at least two images.  
     
     
         45 . A method as claimed in  claim 44 , which includes securing markers on the surgical site at the discrete locations.  
     
     
         46 . A method as claimed in  claim 45 , in which the markers are distinctively colored, monitoring the motion of the discrete locations then including monitoring motion of the distinctively colored markers.  
     
     
         47 . A method as claimed in  claim 27 , wherein the image capture device is in the form of a stereo endoscope, and wherein directing the image capture device at the surgical site further comprises passing a viewing end of the endoscope through an aperture in a chest region of the patient.  
     
     
         48 . A method as claimed in  claim 27  or  claim 40 , which includes analyzing information corresponding to monitored motion history of the surgical site to predict motion of the surgical site.  
     
     
         49 . A method as claimed in  claim 48 , in which computing tracking command signals in response to monitored motion of the surgical site includes computing the tracking command signals from predicted motion of the surgical site.  
     
     
         50 . A method as claimed in  claim 48 , in which predicting motion of the surgical site includes comparing information corresponding to monitored motion of the surgical site with an ECG signal.  
     
     
         51 . A method as claimed in  claim 27 , in which the surgical procedure is to be performed in a minimally invasive manner, wherein positioning the end effector in close proximity to the surgical site on the heart further comprising passing the end effector through an aperture in a chest region of the patient. A method as claimed in  claim 1 , in which the surgical procedure is to be performed in a minimally invasive manner, positioning the end effector in close proximity to the surgical site on the heart then including passing the end effector through a relatively small aperture in a chest region of the patient.  
     
     
         52 . A system for performing a surgical procedure on a beating heart of a patient, the system including: 
 a robotically controlled arm having an end effector mounted thereon, the end effector positionable in close proximity to a surgical site on the heart at which site the surgical procedure is to be performed;    a brace member operatively coupled with the robotically controlled arm, the brace member being arranged to brace, or stabilize, the beating heart so as at least to reduce motion of the surgical site on the beating heart at which site the surgical procedure is to be performed;    means for monitoring motion of the surgical site;    means for computing end effector tracking command signals in response to monitored motion of the surgical site;    means for forwarding the tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the end effector generally to track motion of the surgical site;    means for inputting an end effector movement command signal; and    means for forwarding the end effector movement command signal to the actuators to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site.    
     
     
         53 . A system for performing a surgical procedure on a beating heart of a patient, the system including: 
 a robotically controlled arm having an end effector mounted thereon, the end effector positionable in close proximity to a surgical site on the heart at which site the surgical procedure is to be performed;    means for monitoring motion of the surgical site;    means for computing end effector tracking command signals in response to monitored motion of the surgical site;    means for forwarding the tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the end effector generally to track motion of the surgical site;    means for inputting an end effector movement command signal;    means for forwarding the end effector movement command signal to the actuators to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site;    means for directing an image capture device to the surgical site to capture at least one image of the surgical site; and    means for processing information related to the at least one image to create in an image of the surgical site which appears as though the surgical site were generally stationary relative to the image capture device.