Study Of Computer Aid Preoperative Planning System In Robot-assisted Cardiac Surgery

Background:Preoperative planning (PP) is the planning of the route, site of port andincision, program and method before the operation which are based on theimage of focus and the surgeon's knowledge. During the robot-assisted cardiacsurgery, improper port placement and surgical panel set-up could not attach thegoal of mini-invasive and would lead to the failure of the operation. So ascientific, objective and individual preoperative planning system is demandedfor clinical use of robot-assisted cardiac surgery.Object:The aim of this study is to setup the computer aid preoperative planning(CAPP) system for the robot assist cardiac surgery which is scientific,objective and individual, using 3-D image reconstruction, common softwarequadratic development, quantitative analysis and simulation technology.Methods:(1) The object of preoperative planning is the 3-D model of the operativeregion which is reconstructed with software and CT scan images.(2) The 3-D reconstructive model is then transferred into CAD designplatform (UG). A unique computer aid preoperative planning system isdesigned to realize the port placement optimization and robot base planningbased on the results of forerunner's research and analysis of operativemanipulation.(3) Simulation platform adaptable of the planning system is developed tomake the simulative motion of the robot arms by the quadratic developmentof Adams.Results:The computer aid preoperative planning system for the robot assist cardiac surgery which is scientific, objective and individual could be set up by using3-D image reconstruction, common software quadratic development,quantitative analysis and simulation technology.The Second PartObjective:Two different programs are designed in the computer aid preoperativeplanning system for the demand of robot assisted ASD (atrial spetal defect)treatment and coronary artery bypass grafting (CABG). The computer aidpreoperative planning system is assessed by the comparison with traditionalpreoperative planning (TPP) method in the two operations.Method 1:This group is composed by 12 patients with ASD. Computer aidpreoperative planning program is designed and studied for the robot assistedtreatment of ASD with endoscopic occlusion and surgical repair. Theparameters of the distance between endoscope and surgical site (d),endoscope visual angle (α), motion parameter of both hands (β1,β2) andmotion scope (γ) gained with CAPP and TPP are compared in two differentprocedures. Statistic analysis of paired T test for single parameter andmultivariate analysis of variance (Wilks'Lambda) for comprehensiveparameters is carded out.Results 1:The mean value of the parameters d,α,β1,β2 andγby CAPP system are43.3±8.32mm, 20.46±9.36°, 2.47±1.95°, 6.73±4.81°and 78.27±28.11mm. Theparameters are 78.55±19.23mm, 52.4±9.36°, 7.66±6.77°, 21.73±10.31°and53.00±22.81mm by TPP1 for robot assisted ASD occlusion, and63.98±12.75mm, 48.76±15.47°, 7.66±6.77°, 14.28±12.11°, 70.40±15.36mm byTPP2 for robot assisted ASD surgical repair. There is significant difference ofparameter d,α,β1,β2 between CAPP and TPP1 by paired T test, and so isthe same between CAPP and TPP2 (P＜0.01). But there is no difference inparameter of motion scopeγ(P=0.054, TPP 1) (P=0.297, TPP 2).Multivariate analysis of variance shows significant difference between CAPPand TPP (P＜0.0001). The F values of Wilks' Lambda are 88.43 and 63.35 byTPP 1 and TPP 2, respectively. It can be concluded that CAPP system designed by us is much better than TPP for robot assist ASD treatment in term ofpreoperative planning.Method 2:Computer aid preoperative planning program for the robot assist CABG isset up. The program is evaluated in patients with single vessel disease who arecandidate of LIMA-LAD. The definition of parameters for robot assist CABGis a little different from those for robot assist ASD treatment.Results 2:The parameters for robot assist CABG are 59.48±10.41mm, 56.67±13.69°,18.50±4.17°, 23.32±4.41°, 72.61±35.12mm by CAPP, and 84.33±16.27mm,94.62±11.11°, 38.45±13.91°, 39.62±18.01°, 70.14±16.16mm by TPP. There issignificant difference of parameter d,α,β1,β2 between CAPP and TPP by Ttest (P＜0.05). But there is no difference in parameter of motion scopeγ(P=0.8387). Multivariate analysis of variance shows significant differencebetween CAPP and TPP (F=16.18, P=0.0042). It can be concluded that CAPPsystem designed by us is much better than TPP for robot assist CABG in termof preoperative planning.Conclusion:1. A unique computer aid preoperative planning system for the robot assistedcardiac surgery is developed using the 3-D reconstruction, common softwarequadratic development, quantitative analysis and simulation technology.2. It is confirmed that the computer aid preoperative planning system issuperior to traditional preoperative planning. It has scientific, objective andindividual features.3. The computer aids preoperative planning system has been tested andsimulated in the robot assist ASD occlusion and surgical repair, and robotassist CABG (LIMA-LAD). The result of preoperative planning by this systemis satisfactory. It can be applied in robot assist cardiac surgery universally,scientifically, and conveniently. It is of opening exertion property and issuitable for the demands of different robot assisted cardiac surgery.