Towards Robotic Transseptal Puncture: A Preliminary Study Investigating the Influence of Puncture Velocity in Minimally Invasive Cardiovascular Surgery

Luca Carlini, Anna Bicchi, Junling Fu, Elena De Momi

Abstract:

Abstract—Minimally invasive cardiac surgery (MICS) has
revolutionized cardiovascular interventions. A crucial step
during many MICS targeting the left side of the heart is
the transeptal puncture (TP) performed in the fossa ovalis
(FO). Performing a manual TP poses challenges, requiring a
high level of expertise and a steep learning curve. This has
motivated interest in the exploration of robotic transseptal
puncture, aiming to improve the accuracy of execution. This
study conducts a comprehensive analysis of the impact of
puncture speed on TP safety using a robotic implementation
system and a specially designed FO simulator. Specifically, a 7
Degree of Freedoms (DoFs). manipulator was used to perform
the puncture using the standard transseptal kit commonly used
in manual TP. Moreovere, to measure the interaction forces
between the needle and the tissue, a load cell was attached to
the base of the end effector of the manipulator. The simulator
was built and validated against existing models proposed in the
literature, successfully replicating the anatomical features and
mechanical properties of the fossa ovalis tissue. Experimental
results demonstrate that higher puncture velocities are associ
ated with reduced needle shear forces, improving the overall
safety of the procedure.