Automated knot tying for fixation in minimally invasive, robot-assisted cardiac surgery.

Cardiovascular disease (CVD) is perhaps the most significant worldwide health issue. While open-heart surgery remains the predominant treatment, significant advancements have been made in minimally invasive surgery (MIS) and minimally invasive robot-assisted (MIRA) surgery. MIRA techniques offer many advantages over open-heart procedures and have extended the capabilities of MIS. However, these benefits come at the cost of increased operating times due to time spent tying knots. The additional bypass time limits patient access and is the most significant barrier to the adoption of MIRA techniques. This research seeks to overcome this barrier by designing a device for MIRA cardiac procedures that automates the knotting of sutures. If this task can be automated while ensuring the delivery of high-quality knots, great progress can be made in transforming the field. MIRA cardiac procedures can move from novel procedures performed by a select group of surgeons on a limited pool of patients to a viable alternative available to the majority of patients with CVD. In this research we propose a design for a self-contained device that delivers a locking knot. Results suggest that consistent knots can be delivered at a time savings of 12.5% and 26.4% over manual knots for trained and untrained users of a surgical robot, respectively.

Improved xenograft survival with continuous infusion deoxyspergualin and RATG.

The critical shortage of available donor organs is the major limit to current allogeneic transplantation. Xenografting has the potential to overcome this difficult problem. Suppressing the vigorous rejection response remains a major obstacle to the clinical application of xenografting, 15-Deoxyspergualin (DOSP), a potent new immunosuppressive agent has been shown to be effective in allogeneic and xenogeneic experimental models. This study tests DOSP in combination with rabbit antithymocyte globulin (RATG) in the hamster-to-rat cardiac xenograft. Results show that combination therapy with DOSP/RATG was superior to treatment with either agent alone (p less than .05). Optimal graft prolongation (20.9 days versus control of 3.1 days, p less than .05) was achieved with combination therapy of RATG and DOSP 2.5 mg/kg day-1 by continuous infusion.