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The Role of Visualization, Force Feedback, and Augmented Reality in Minimally Invasive Heart Valve Repair

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The Role of Visualization, Force Feedback, and Augmented Reality in Minimally Invasive Heart Valve Repair Western University Scholarship@Western Electronic Thesis and Dissertation Repository 11-20-2015 12:00 AM The Role of Visualization, Force Feedback, and Augmented Reality in Minimally Invasive Heart Valve Repair Maria E. Currie The University of Western Ontario Supervisor Dr. T. Peters The University of Western Ontario Graduate Program in Biomedical Engineering A thesis submitted in partial fulfillment of the equirr ements for the degree in Doctor of Philosophy © Maria E. Currie 2015 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Biomedical Engineering and Bioengineering Commons Recommended Citation Currie, Maria E., "The Role of Visualization, Force Feedback, and Augmented Reality in Minimally Invasive Heart Valve Repair" (2015). Electronic Thesis and Dissertation Repository. 3397. https://ir.lib.uwo.ca/etd/3397 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. THE ROLE OF VISUALIZATION, FORCE FEEDBACK, AND AUGMENTED REALITY IN MINIMALLY INVASIVE HEART VALVE REPAIR (Thesis format: Integrated Article) by Maria Elizabeth Currie Biomedical Engineering Graduate Program A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy The School of Graduate and Postdoctoral Studies Western University London, Ontario, Canada © Maria Elizabeth Currie, 2015 Abstract New cardiovascular techniques have been developed to address the unique requirements of high risk, elderly, surgical patients with heart valve disease by avoiding both sternotomy and cardiopulmonary bypass. However, these techniques pose new challenges in visualization, force application, and intracardiac navigation. Force feedback and augmented reality (AR) can be applied to minimally invasive mitral valve repair and transcatheter aortic valve implantation (TAVI) techniques to potentially surmount these challenges. Our study demonstrated shorter operative times with three dimensional (3D) visualization compared to two dimensional (2D) visualization; however, both experts and novices applied significantly more force to cardiac tissue during 3D robotics-assisted mitral valve annuloplasty than during conventional open mitral valve annuloplasty. This finding suggests that 3D visualization does not fully compensate for the absence of haptics, including force feedback, in robotics-assisted cardiac surgery. Subsequently, using an innovative robotics- assisted surgical system design, we determined that direct force feedback may improve both expert and trainee performance using robotics-assisted techniques. We determined that during robotics-assisted mitral valve annuloplasty the use of either visual or direct force feedback resulted in a significant decrease in forces applied to cardiac tissue when compared to robotics-assisted mitral valve annuloplasty without force feedback. We presented NeoNav, an AR-enhanced echocardiograpy intracardiac guidance system for NeoChord off-pump mitral valve repair. Our study demonstrated superior tool navigation accuracy, significantly shorter navigation times, and reduced potential for injury with AR enhanced intracardiac navigation for off-pump transapical mitral valve repair with neochordae implantation. In addition, we applied the NeoNav system as a safe and inexpensive alternative imaging modality for TAVI guidance. We found that our proposed AR guidance system may achieve similar or better results than the current standard of care, contrast enhanced fluoroscopy, while eliminating the use of nephrotoxic contrast and ionizing radiation. ii These results suggest that the addition of both force feedback and augmented reality image guidance can improve both surgical performance and safety during minimally invasive robotics-assisted and beating heart valve surgery, respectively. Keywords Mitral Valve Repair, Mitral Valve Regurgitation, Robotics-Assisted Cardiac Surgery, Force Feedback, Augmented Reality, Transcatheter Aortic Valve Replacement iii Co-Authorship Statement Chapter 2 is adapted the following work: Currie ME, Trejos AL, Rayman R, Chu MWA, Patel R, Peters TM, Kiaii B. The role of three-dimensional visualization in robotics-assisted cardiac surgery. Proc SPIE 2012; 8316: 83160F1-10. Currie ME, Romsa J, Fox S, Vezina WC, Akincioglu C, Warrington JC, McClure RS, Stitt LW, Menkis AH, Boyd WD, Kiaii B. Long-term angiographic follow-up of robotics- assisted coronary artery revascularization. Ann Thorac Surg 2012;93:1426-1431. Currie ME, Trejos AL, Rayman R, Chu MWA, Patel R, Peters TM, Kiaii B. Evaluating the effect of three dimensional visualization on force application and performance time during robotics-assisted mitral valve repair. Innovations (Phila) 2013; 8(3): 199-205. My contribution to this chapter involved (i) designing the surgical test bed, (ii) conducting experiments, and (iii) analyzing data. All authors participated in data acquisition and manuscript preparation. Chapter 3 is adapted from the following work: M. E. Currie, A. L. Trejos, R. Rayman, M. W. A. Chu, R. Patel, T. M. Peters, B. Kiaii. The role of haptics in robotics-assisted mitral valve annuloplasty. Hamlyn Symposium on Medical Robotics, July 2012, London, England. Visual and Direct Haptic Feedback in Robotics-Assisted Cardiac Surgery. M. E. Currie, A. Talasaz, A. L. Trejos, R. Rayman, M. W. A. Chu, B. Kiaii, T. M. Peters, R. Patel. Minimally Invasive Robotic Association International Congress, September 2012, Boston, USA. M. E. Currie, A. Talasaz, A. L. Trejos, R. Rayman, M. W. A. Chu, B. Kiaii, R. Patel, T. M. Peters. The Role of Visual and Direct Haptics in Robotics-Assisted Mitral Valve Annuloplasty. Journal of Medical Robotics and Computer Assisted Surgery (Submitted). This work involved collaboration with Dr. Ali Talasaz designed and wrote complex control algorithms and a safety system for the 7-DOF dual arm teleoperation system with force iv feedback, Dr. Ana Luisa Trejos sensorized the da Vinci needle drivers used in the experimental work, Dr. Harman Bassan performed mechanical design of the grasping mechanism of the 7-DOF Haptic Wand, and with Simon Perreault helped with development of kinematics modeling of the 7-DOF Haptic Wand and the da Vinci needle driver instrument. Drs. R. Rayman and M. W. A. Chu performed the trials and contributed to preparation of the manuscript. Drs. B. Kiaii, R. Patel, and T. Peters supervised the experiments and presentations, and were involved in manuscript preparation. My contribution to this chapter involved (i) designing the surgical test bed (ii) conducting experiments and (iii) analyzing data. Chapter 4 is adapted from the following work: Chu MW, Moore J, Peters T, Bainbridge D, McCarty D, Guiraudon GM, Wedlake C, Lang P, Rajchl M, Currie ME, Daly RC, Kiaii B. Augmented reality image guidance improves navigation for beating heart mitral valve repair. Innovations (Phila). 2012 Jul-Aug; 7(4): 274-81. Moore JT, Chu MW, Kiaii B, Bainbridge D, Guiraudon G, Wedlake C, Currie M, Rajchl M, Patel RV, Peters TM. A navigation platform for guidance of beating heart transapical mitral valve repair. IEEE Trans Biomed Eng. 2013 Apr; 60(4): 1034-40. This work involved collaboration with Neochord, Inc. and Dr. Richard Daly who contributed to the design and use of the NeoChord device. It is important to note the significant contributions of the following individuals in the design and implementation of the NeoNav guidance system. Chris Wedlake wrote the programs for augmented reality tracking. John Moore constructed the magnetically tracked devices, tested their effectiveness, and organized the navigation trials with surgeons. My contribution to these manuscripts involved organizing and conducting experiments. The remainder of the chapter is a summary of: Currie ME. NeoChord Progress Report. Safety and performance study of the NeoChord Suturing Device in subjects with degenerative mitral valve disease diagnosed with severe mitral regurgitation. NeoChord. September, 2013. v This report was submitted as part of an agreement with NeoChord, Inc. Chapter 5 is adapted from the following work: McLeod AJ, Currie ME, Moore JT, et al. Phantom study of an ultrasound guidance system for transcatheter aortic valve implantation. Comput Med Imaging Graphics. 2014 Dec 15. Currie ME, McLeod AJ, Moore JT, Chu MWA, Patel R, Kiaii B, Peters T. Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation. Innovations (Phila). Accepted 2015. My contribution to this chapter involved designing and conducting experiments and analyzing data. vi Acknowledgments This work was not a solitary endeavour and I wish to express gratitude to all those who have contributed to the completion of this thesis. First and foremost, I am particularly thankful to my thesis supervisors Dr. Terry Peters, Dr. Rajni Patel, and Dr. Bob Kiaii for their valuable teaching, guidance, and support. I also wish to acknowledge the members of my examination committee for their helpful criticism and insightful suggestions. In addition, I am grateful to all members of both Dr. Peters’ Imaging Laboratory and Dr. Patel’s CSTAR lab for their teaching, guidance, collaboration, and friendship, with special thanks to Dr. Ana Luisa Trejos, Dr. Ali Talasaz, Chris Ward, Abelardo Escoto, Jonathan McLeod, John Moore, and Chris Wedlake. Furthermore, I am grateful for
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