A Highly Articulated Robotic Surgical System for Minimally Invasive Surgery Takeyoshi Ota, MD, PhD, Amir Degani, MS, David Schwartzman, MD, Brett Zubiate,

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A Highly Articulated Robotic Surgical System for Minimally Invasive Surgery Takeyoshi Ota, MD, PhD, Amir Degani, MS, David Schwartzman, MD, Brett Zubiate, BS, Jeremy McGarvey, MD, Howie Choset, PhD, Marco A. Zenati, MD The Annals of Thoracic Surgery Volume 87, Issue 4, Pages 1253-1256 (April 2009) DOI: 10.1016/j.athoracsur.2008.10.026 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Distal apparatus of the CardioARM consisting of cylindrical links articulated by spherical joints. (B) The feeder instrumentation box contains all mechanics necessary for probe manipulation, which includes motors for controlling the cables and actuators for the driving system. The Annals of Thoracic Surgery 2009 87, 1253-1256DOI: (10.1016/j.athoracsur.2008.10.026) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative pictures during porcine trials. (A) The CardioARM is mounted on the operating table using a custom mounting frame. The onboard optic fiber view is displayed on the monitor (arrow). (B) A small subxiphoid incision and small pericardiotomy are manually made under direct visualization. The distal apparatus of the CardioARM passes through the pericardiotomy. The Annals of Thoracic Surgery 2009 87, 1253-1256DOI: (10.1016/j.athoracsur.2008.10.026) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The accomplished courses of the distal apparatus of the CardioARM in the navigation trials. (A) Front view. (B) Left lateral view. (#1 = superior vena cava; #2 = right atrial appendage; #3 = ascending aorta; #4 = left atrial appendage; #5 = transverse sinus; #6 = atrioventricular groove.) The Annals of Thoracic Surgery 2009 87, 1253-1256DOI: (10.1016/j.athoracsur.2008.10.026) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) A picture of the onboard view during the epicardial ablation trials. (B) The distal apparatus of the CardoARM is seen through the pericardium (arrow). The tip of the robot is navigated to the left atrial appendage over the lateral wall of the heart. A left thoracotomy was created only for photographing probe movement. (C) A linear “dot-to-dot” lesion at the base of the left atrial appendage of the excised heart. (LAA = left atrial appendage.) The Annals of Thoracic Surgery 2009 87, 1253-1256DOI: (10.1016/j.athoracsur.2008.10.026) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions