Innovative Flexible Robotic Arm for Enhanced Precision in Transaortic Surgical Myectomy

Abstract Hypertrophic cardiomyopathy causes thickening of the interventricular septum, obstructing outflow and increasing the risk of arrhythmia, stroke, and sudden death. The initial treatment would be medication; however, if the symptoms do not improve with it, the transaortic septal myectomy would be performed as the most common procedure. The procedure is quite challenging due to limited visibility and restricted space. Most complications arise from this limitation and include septal perforation due to excessive removal of the muscles, insufficient cutting of the septum leading to unsuccessful surgery, and damage to the heart valves. To tackle these issues, we propose designing a compact, hand-held, wire-driven robotic arm specifically for intracardiac myectomy. This robotic arm features a cable-driven continuum structure, a shape-memory-alloy (SMA) actuated locking mechanism, a miniature endoscopic camera located at the distal end, a scalpel as the surgical instrument, and an interface for controlling the arm. This paper discusses the mechanical design and control of the robotic arm, along with feasibility studies and simulation results. This arm is anticipated to offer a novel approach for surgeons to enhance surgical precision and minimize errors while maintaining a minimally invasive procedure.