This Laboratory is a place where the initial verification of manufactured products is carried out and where random sample testing penetrating new directions of development of bioengineering and cardiac surgery is conducted. The Laboratory performs basic research on the artificial heart and lab tests on heart valve prostheses; it conducts first trials on models and prepares their subsequent modifications. It administers unique research equipment, largely of its own design, allowing to investigate blood flow processes, to analyse the dynamics of the operation of the prostheses, and to improve them continuously. In recent years the laboratory has become a first-rate specialist in the field of medical robotics. It performs works relating to such projects as: - medical robotics and mechatronic surgical instruments (Poland’s first surgical robots called Robin Heart) – innovative methods supporting surgery (including Poland’s most advanced surgery consulting methods based on computer simulations and physical modelling, as well as trailblazing methods of planning surgical procedures, making use of virtual space technologies) – designing devices and developing methods of testing artificial organs and biomaterials (unique research techniques and test stands). Regarding the above, the research and scientific activities of the Laboratory are divided into three main areas: ROBOT, EXPERT, TEST.
The goal of the project is to develop a surgical robot and a new generation of instruments boosting precision, safety, and scope of application of little-invasive surgery. The Foundation has initiated the construction of surgical robots in Poland, assuming the role of a pioneer in this respect. It is also a place of knowledge promotion, exchange of views, experiences, and practical science relating to the application of the robots and mechatronic instruments developed. The effect of the works conducted since 2000 is a prototype family of Robin Heart robots with a segment structure, enabling to compile equipment for different types of surgical procedures. The family of Polish robots called Robin Heart consists of three models: Robin Heart 0, Robin Heart 1 (with an independent base and controlled by an industrial computer), and Robin Heart 2 (mounted on the treatment table, equipped with two arms on which different surgical instruments or a visual track with an endoscopic camera can be installed). Currently, works and tests are in progress aiming to improve and optimise their technology so as to turn the prototypes into a family of products appropriate for clinical application. In 2007-2008 a robot called Robin Heart Vision was developed; its goal is to control the position of the endoscopic visual track. It is to be first to reach operating theatres and to pave the way to the clinic for the entire family of the robots developed. The robot is controlled in an ergonomic console called Robin Heart Shell, imitating the surgeon’s work ‘inside the patient’s body’. The plans comprise the next project, Robin Heart PortVisionAble, which would be a response to the demand of the world of medicine for light, portable, robotised station controlling the position of the endoscopic camera.
Furthermore, works are in progress on the development and implementation of fully original, special mechatronic surgical instruments Robin Heart Uni System (such as e.g. a needle-holder, scalpel scissors, a riveting machine, a stapler, cannula implementation and tissue suturing instruments), which can be mounted on the robot’s arm (controlled from the console of the robot), or held in a special holder (manual orientation and control). Procedures performed by means of such tools, introduced through small openings in the patient’s body, will be less traumatic and invasive, and they will shorten the duration of the surgical procedure itself, as well as the recovery period.
In January 2009 the robots and the mechatronic surgical instruments were tried in the first experimental tests on animals, in the Experimental Medicine Centre of the Medical University of Silesia in Katowice. The surgical procedure of cholecystectomy and surgical repair of heart valves was attended by distinguished cardiac surgeons: Romuald Cichoń, Joanna Śliwka, Grzegorz Religa, Michał Zembala. Robin Heart Vision did perfectly well during the procedures on animals. Performing tasks connected with the control of the position of the endoscopic track, it satisfied the expectations of its designers and users. The collected feedback was used in the improvement of the instruments and other elements of the surgical robot. On its basis, in 2009, a decision was made to build a completely new version of the robot, Robin Heart m2, which would address the needs of precise operation in conventional endoscopic procedures, as well as in small areas (e.g. harvesting blood vessels to the so-called bypasses) and in surgical procedures via patient’s natural orifices.
In 2005, within the scheme of EU funds, the Robin Heart Service Department was established for the benefit of the future commercialisation of robotised devices developed in the Foundation.
The goal of the project is to develop new methods supporting the process of planning, consulting, preparing surgical procedures, and training surgeons. In the years 1997-2000 the Biocybernetics Laboratory conducted Poland’s first innovative and unique research project devoted to simulations of surgical procedures. It allows to optimise the effect of a surgical procedure, especially in the cardiovascular system, applying methods of physical and mathematical modelling and computer simulations. The simulation procedure may be applicable especially in surgeries of congenital heart diseases in children. It can be performed in the general form, as well as towards a specific patient. Within the scheme of the programme of surgical procedures simulations, model tests are performed, e.g. of the Blalock-Taussig shunt, the Fontan procedure, the Batista procedure, and the coronary artery by-pass surgery, as well as a data bank of congenital heart diseases is created.
Furthermore, specialised expert programmes for surgeons are developed, e.g. pertaining to the application of artificial organs or new instruments. For teaching purposes, a robotic operating theatre is being developed, where one can control all its elements in an integrated manner. For teaching and research purposes, the most recent achievements in the field of interactive virtual space are applied – it will enable to test a real robot on a virtual patient for a selected type of surgical treatment. This way a virtual operating theatre (based on software by EON) is used as a training station for future surgeons, who are able to get to know the behaviour and control methods of the Robin Heart robot; as a tool for planning surgical procedures, with an option of providing guidelines step by step for a specific course of action. It can be also applied in a consulting programme, when a voice command during a surgical procedure can activate a procedure previously practiced on a virtual model. The virtual reality technology is also used in the process of designing new surgical instruments – as early as at the designing stage we can evaluate the instrument’s applicability in a specific space on a model of a patient. Besides making use of the opportunities offered by virtual space, e-education skills are being developed, as well, on the basis of the experience gained during teleconferences and while teaching classes by means of e-learning technologies. In 2009 several new training stations were implemented and several shows and workshops devoted to surgery were organised, e.g. demonstrating the Duo Teacher station. It consists of two mechatronic training stations, combined with a computer supervision system. They allow to interactively learn how to use surgical instruments, especially in the less invasive laparoscopic surgery, by means of performing tasks in the real time in the ‘master-student’ mode, as well as observing and analysing their reactions on the monitor. Simultaneously, design works on the educational system called Robin Heart Virtual Teacher are in progress. It will consist of a control console and a computer programme called Virtual Operating Theatre, intended for learning and testing the use of instruments of the less invasive surgery, most of all of the Polish Robin Heart robots.
The team of the Biocybernetics Laboratory are constantly developing their research skills and implement new projects. The result of this work are test stands of laser visualisation and anemometric measurements of the liquid flow, physical models of the circulatory system, a full system of heart valve testers, a test stand testing biomechanical properties of tissues, pneumatic and electromechanical controllers of the testers, a simple pneumatic drive of the artificial heart. All test stands are computer-controlled, based on original software of the control system and automatic data monitoring, archiving, and development. Simultaneously with the tests on physical models, computer simulations of the flow and mathematical simulations of the models are performed, along with in vitro studies of haemolysis and coagulation of blood, which is particularly important in the process of developing new blood pumps.
The goal of the TEST project is constant development of scientific and research facilities via further construction of specialised stations, design of devices, and development of research methods, as well as conducting basic research by means of the above, supporting designing, research, consulting works pertaining to artificial organs and biomaterials. The development of unique testing methods applied at different stages of the design works on heart prostheses, biomaterials, and surgical robots brought about original devices and test stands, as well as the experience of Poland’s leader in this field, currently applied in further design works, specialised tests for medical centres, and in academic teaching. The goal of the development of the scientific activity in the scope referred to above is strengthening of the position of a specialised partner in research and development works connected with testing artificial organs and biomaterials, with commercial and development studies for medicine and for the medical industry. One of the elements which are indispensable to be able to implement this vision is obtaining a relevant status in European network of laboratories and certification of the laboratory in a selected scope. The tests performed, the devices developed, and the testing techniques constitute an element of the procedure of preparing new hearth prostheses, as well as support clinical assessment of the application thereof. Every year in order to improve the efficiency of the circulatory system hundreds of thousands of prostheses of heart valves, blood vessels, thousands of cardiac stimulators and blood pumps are implanted, restoring health in nearly one million patients. The occurring damages and material defects (biodegradation) are the main cause of reoperations and replacements of prostheses with new ones, and they inspire to look for new materials and better technological solutions to be adopted in the design of prostheses. The Foundation conducts Poland’s only activities focused on the development of research procedures, organisation of a network of laboratories and a database comprising results of tests in several groups of prostheses intended for the circulatory system, commonly applied in patients. The project is an effect of our engagement in the European project COST 537, and its result is Europe’s largest collection of explanted prostheses of the cardiovascular system, gathered by the Foundation. Comprehensive tests of obtained biological and mechanical heart valves homografts and prostheses (grafts) are performed according to clearly defined procedures. This way over 100 prostheses of the cardiovascular system have been examined.
Since January 2012 the Foundation of Cardiac Surgery Development has participated in an international project the objective of which is the development of an arm of a surgical robot exhibiting variable, controlled rigidity and geometry. A team of robotics specialists from King’s College London (Centre for Robotics Research at King’s College London) under the supervision of Prof. Kaspar Althoefer and Prof. Prokar Dasgupta – a surgeon making use of robots during surgical procedures, watching perfect solutions created by nature, particularly the movements and anatomy of the octopus, launch their works on a robot that would exhibit motor features similar to those of the octopus.
In this project, the Biocybernetics Laboratory of the Institute of Hearth Prostheses is responsible for the development of a system of tests intended for the robot (stations for planning surgeries and training surgeons, and stations for technical tests to be performed on the robot), as well as for the robot control console.
The project entitled ‘Stiff-Flop: Smart stiffness controlling, flexible surgical manipulator’, is implemented in the scheme of the 7th Framework Programme of the European Union. Besides our Foundation, 11 international partners participate in it: from the United Kingdom, Germany, Italy, Spain, Israel, and Poland.
The first workshop for the group of foreign scientists engaged in the Stiff-Flop projects is planned for the end of this year. It will precede the annual International Conference Medical Robots, which on 7 December 2017 will have its 10th edition.