The role of three-dimensional visualization in robotics-assisted cardiac surgery

Objectives: The purpose of this study was to determine the effect of three-dimensional (3D) versus two-dimensional (2D) visualization on the amount of force applied to mitral valve tissue during robotics-assisted mitral valve annuloplasty, and the time to perform the procedure in an ex vivo animal model. In addition, we examined whether these effects are consistent between novices and experts in robotics-assisted cardiac surgery. Methods: A cardiac surgery test-bed was constructed to measure forces applied by the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) during mitral valve annuloplasty. Both experts and novices completed roboticsassisted mitral valve annuloplasty with 2D and 3D visualization. Results: The mean time for both experts and novices to suture the mitral valve annulus and to tie sutures using 3D visualization was significantly less than that required to suture the mitral valve annulus and to tie sutures using 2D vision (p∠0.01). However, there was no significant difference in the maximum force applied by novices to the mitral valve during suturing (p = 0.3) and suture tying (p = 0.6) using either 2D or 3D visualization. Conclusion: This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery. Keywords: Robotics-assisted surgery, visualization, cardiac surgery

[1]  P. Vos,et al.  Robotic mitral valve repair for anterior leaflet and bileaflet prolapse. , 2008, The Annals of thoracic surgery.

[2]  Evelio Rodriguez,et al.  Robotic cardiac surgery , 2006, The international journal of medical robotics + computer assisted surgery : MRCAS.

[3]  Y. Woo,et al.  Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay , 2006 .

[4]  F. Mohr,et al.  Computer-enhanced coronary artery bypass surgery. , 1999, The Journal of thoracic and cardiovascular surgery.

[5]  A. Darzi,et al.  The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons , 1999, Surgical Endoscopy.

[6]  Rajnikant V. Patel,et al.  Robot-assisted Tactile Sensing for Minimally Invasive Tumor Localization , 2009, Int. J. Robotics Res..

[7]  Eugene H Blackstone,et al.  Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized. , 2011, The Journal of thoracic and cardiovascular surgery.

[8]  C Cardon,et al.  [Computer assisted open heart surgery. First case operated on with success]. , 1998, Comptes rendus de l'Academie des sciences. Serie III, Sciences de la vie.

[9]  W. Chitwood,et al.  Robotic mitral valve surgery: a United States multicenter trial. , 2005, The Journal of thoracic and cardiovascular surgery.

[10]  David C. Knill,et al.  Integrating visual cues for motor control: A matter of time , 2005, Vision Research.

[11]  Klaus Radermacher,et al.  Stereoscopic Visualization in Endoscopic Surgery: Problems, Benefits, and Potentials , 1997, Presence: Teleoperators & Virtual Environments.

[12]  Hartzell V Schaff,et al.  Robotic mitral valve repair for all categories of leaflet prolapse: improving patient appeal and advancing standard of care. , 2011, Mayo Clinic proceedings.

[13]  G. Hubens,et al.  A performance study comparing manual and robotically assisted laparoscopic surgery using the da Vinci system , 2003, Surgical Endoscopy And Other Interventional Techniques.

[14]  M. Goodale,et al.  Binocular vision and the on-line control of human prehension , 2004, Experimental Brain Research.

[15]  K. Bland,et al.  Comparison of learning curves and skill transfer between classical and robotic laparoscopy according to the viewing conditions: implications for training , 2008 .

[16]  Nicholas J. Wade,et al.  Perceptual Aspects of Two-dimensional and Stereoscopic Display Techniques in Endoscopic Surgery: Review and Current Problems , 2001, Seminars in laparoscopic surgery.

[17]  K. Moorthy,et al.  The benfits of stereoscopic vision in robotic-assisted performance on bench models , 2004, Surgical Endoscopy And Other Interventional Techniques.

[18]  A. Cuschieri,et al.  Randomised study of influence of two-dimensional versus three-dimensional imaging on performance of laparoscopic cholecystectomy , 1998, The Lancet.

[19]  W. Chitwood,et al.  Minimally invasive mitral valve repair using transthoracic aortic occlusion. , 1997, The Annals of thoracic surgery.

[20]  A. Szold,et al.  Three-dimensional imaging improves surgical performance for both novice and experienced operators using the da Vinci Robot System. , 2007, American journal of surgery.

[21]  P. Vos,et al.  Robotic mitral valve repairs in 300 patients: a single-center experience. , 2008, The Journal of thoracic and cardiovascular surgery.

[22]  W. Chitwood,et al.  Video-assisted minimally invasive mitral valve surgery: the "micro-mitral" operation. , 1997, The Journal of thoracic and cardiovascular surgery.

[23]  F. Casselman,et al.  Endoscopic mitral valve repair: feasible, reproducible, and durable. , 2003, The Journal of thoracic and cardiovascular surgery.

[24]  M O Schurr,et al.  The role and future of endoscopic imaging systems. , 1999, Endoscopy.

[25]  R. M. Satava,et al.  3-D vision technology applied to advanced minimally invasive surgery systems , 1993, Surgical Endoscopy.

[26]  Jeevanantham Rajeswaran,et al.  Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. , 2010, The Journal of thoracic and cardiovascular surgery.

[27]  Melvyn A. Goodale,et al.  The role of binocular vision in prehension: a kinematic analysis , 1992, Vision Research.

[28]  A. Cuschieri,et al.  Comparison of direct vision and electronic two‐ and three‐dimensional display systems on surgical task efficiency in endoscopic surgery , 1995, The British journal of surgery.

[29]  A. Berrebi,et al.  Less invasive techniques for mitral valve surgery. , 1998, The Journal of thoracic and cardiovascular surgery.

[30]  J. Fann,et al.  Influence of three-dimensional vision on surgical telemanipulator performance , 2001, Surgical Endoscopy.

[31]  P. Servos.  Distance estimation in the visual and visuomotor systems , 2000, Experimental Brain Research.

[32]  J. Himpens,et al.  Telesurgical laparoscopic cholecystectomy , 1998, Surgical Endoscopy.

[33]  W. Chitwood,et al.  Robotic mitral valve repair: experience with the da Vinci system. , 2003, The Annals of thoracic surgery.