Zbigniew Nawrat

Norwood with right ventricle-to-pulmonary artery conduit is more effective than Norwood with Blalock–Taussig shunt for hypoplastic left heart syndrome: mathematic modeling of hemodynamics,

OBJECTIVE The introduction of right ventricle to pulmonary artery (RV-PA) conduit in the Norwood procedure for hypoplastic left heart syndrome resulted in a higher survival rate in many centers. A higher diastolic aortic pressure and a higher mean coronary perfusion pressure were suggested as the hemodynamic advantage of this source of pulmonary blood flow. The main objective of this study was the comparison of two models of Norwood physiology with different types of pulmonary blood flow sources and their hemodynamics. METHOD Based on anatomic details obtained from echocardiographic assessment and angiographic studies, two three-dimensional computer models of post-Norwood physiology were developed. The finite-element method was applied for computational hemodynamic simulations. Norwood physiology with RV-PA 5-mm conduit and Blalock-Taussig shunt (BTS) 3.5-mm shunt were compared. Right ventricle work, wall stress, flow velocity, shear rate stress, energy loss and turbulence eddy dissipation were analyzed in both models. RESULTS The total work of the right ventricle after Norwood procedure with the 5-mm RV-PA conduit was lower in comparison to the 3.5-mm BTS while establishing an identical systemic blood flow. The Qp/Qs ratio was higher in the BTS group. CONCLUSIONS Hemodynamic performance after Norwood with the RV-PA conduit is more effective than after Norwood with BTS. Computer simulations of complicated hemodynamics after the Norwood procedure could be helpful in establishing optimal post-Norwood physiology.

The development of internetwork channel emulation platform for surgical robot telemanipulation control system (INSeRT)

In this paper, we describe the RobinHeart surgery robot development related project in which entire robot operation is supposedly done remotely, using wide area network connection. In such environment, any vision and telemanipulation data packets are subject to delay, limitations, issues and failures, as any network connections do. It has become necessary to create an internetwork emulation for the purposes of robot-related trials. The INSeRT platform has been developed to fulfill that role. INSeRT platform design is presented and discussed and first results of validation with real-life example are shown. Network channel manipulation techniques can be implemented at data-link OSI layer level, or it may be induced at network layer level - this approach relies on network layer packet manipulation and poses a promising start, as well as raises questions about whether implementing different distributions for delay or reordering is going to have significant impact on channel emulation and traffic parameters.

Medical robots in cardiac surgery – application and perspectives

Medical robots offer new standards and opportunities for treatment. This paper presents a review of the literature and market information on the current situation and future perspectives for the applications of robots in cardiac surgery. Currently in the United States, only 10% of thoracic surgical procedures are conducted using robots, while globally this value remains below 1%. Cardiac and thoracic surgeons use robotic surgical systems increasingly often. The goal is to perform more than one hundred thousand minimally invasive robotic surgical procedures every year. A surgical robot can be used by surgical teams on a rotational basis. The market of surgical robots used for cardiovascular and lung surgery was worth 72.2 million dollars in 2014 and is anticipated to reach 2.2 billion dollars by 2021. The analysis shows that Poland should have more than 30 surgical robots. Moreover, Polish medical teams are ready for the introduction of several robots into the field of cardiac surgery. We hope that this market will accommodate the Polish Robin Heart robots as well.

Tele-Manipulation System for Minimal Invasive Surgery Support. Prototype for Long Distance Operation

System for remote manipulating of endoscopic vision channel as support for minimal invasive surgery is presented. Original control system for telemanipulator working in Master-Slave configuration is implemented on Real Time system and partially as a interface for Master unit on reprogramovable FPGA, Xilinx, where data acquisition and processing algorithm work directly on silicon. An experimental set-up for long distance operation is also described, where surgeon , operator was steering the Master console in Institute of Heart Prostheses in Zabrze and Slave robot arm, equipped with vision channel or coagulation knife carried out operation on pig heart in Center of Experimental Medicine of Silesian Medical University in Katowice (about 30km distance). Results as delays in audio/video channel and motion data transmission were measured. After tele-lab monitoring and control tasks, presented remote manipulation is next step in the program of tele-projects, carried out by Institute of Heart Prostheses Foundation for Cardiac Surgery Development in Zabrze.

Robin Heart - Perspectives of Application of Mini Invasive Tools in Cardiac Surgery

Robot invented for less, minimally invasive cardiac surgery is a computer-controlled device, located between surgeons hands and the tip of a surgical instrument. Basic requirements for this device are first of all high reliability, stable operative field of view, direct surgeon control and high level of precision. The Robin Heart® is a Europes first heart surgery robot system with whole, original Polish design. Precise and optimally adapted to the surgeons manual dexterity, it also helps him make the right decisions. Around 4 million minimally-invasive surgeries are performed in the world every year. The procedures are performed by means of special instruments inserted through small incisions in the patients body. The aim is to limit the operative field and protect surrounding tissue, which could be damaged if a traditional surgical technique was used. The number of endoscopic procedures, less invasive than traditional surgery, performed through natural orifices in the patients body, or through special openings called ports, is on the rise. The success of the procedures largely depends on the instruments used. Unfortunately, typical endoscopic (laparoscopic) instruments reduce precision and make the surgery more difficult because they add to hand tremor and almost completely eliminate the natural sense of touch. Additionally, the surgeon does not have a direct view of the operative field-a camera inserted into the body through a third opening transmits the image to a display. So the surgeons task is not easy. An ideal non-invasive surgery can be compared to the house renovation through a keyhole without disturbing the household members. Across the world, physicians and engineers are working to develop increasingly effective instruments to enable surgery with the use of the latest technology. But how can one enhance instrument precision and maneuverability, which are so important in the case of surgery on the beating heart, for instance? Surgical robots provide such capabilities. In Poland, an interdisciplinary team led by Prof. Zbigniew Religa already introduced modern devices to clinical practice to save the lives of heart patients. An artificial heart, prosthetic heart valves and recently a surgical robot are the results of projects carried out by the Biocybernetics Laboratory of the Heart Prosthesis Institute, a research center run by the O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m

The preplanning and advisory system for Robin heart-polish telemanipulator for cardiac minimal invasive surgery

Abstract Project of Polish cardiac surgery robot, which is run by Foundation of Cardiac Surgery Development in Zabrze, Poland, in cooperation with scientific centres in Lodz and Warsaw, assumes the development of surgery planning system and introduction of advisory systems for physicians. This work presents the state of art of polish project.