Esta dissertação refere-se `a simulação de um sistema de controle em um manipulador robótico para compensação dos movimentos do coração em cirurgias cardíacas minimamente invasivas. No intuito de compensar os movimentos do batimento cardíaco utilizam-se técnicas de controle híbrido de posição/força e dados dos movimentos do coração obtidos in vivo, utilizadas como elementos básicos para a constituição deste sistema. Tópicos de modelagem de manipuladores robóticos e, em especial, a modelagem da relação entre as forças e deslocamentos na superfície do coração compõe a base estrutural. Focalizou-se, ainda, o papel do controle de força em relação `a posição da ferramenta do manipulador na superfície do coração. Pretende-se que a principal contribuição deste trabalho seja demonstrar que o controlador híbrido segue as restrições impostas pela dinâmica do sistema coração-pulmão. / This paper refers to the simulation of a control system for a robotic manipulator to compensate the movements of the heart in minimally invasive cardiac surgery. In order to compensate the motion of the beating heart techniques are used to implement a hybrid position/force controller based on data and the movements of the heart obtained in vivo, used as references to the input of the system. Topics modeling robotic manipulators, and in particular, modeling the relationship between forces and displacements on the surface of the heart comprises the structural basis. The role of power control over the position of the manipulator tool on the surface of the heart. It is intended that the main contribution of this study is to show that the hybrid controller follows the restrictions imposed by the dynamics of the heart-lung system.

Esta dissertação refere-se `a simulação de um sistema de controle em um manipulador robótico para compensação dos movimentos do coração em cirurgias cardíacas minimamente invasivas. No intuito de compensar os movimentos do batimento cardíaco utilizam-se técnicas de controle híbrido de posição/força e dados dos movimentos do coração obtidos in vivo, utilizadas como elementos básicos para a constituição deste sistema. Tópicos de modelagem de manipuladores robóticos e, em especial, a modelagem da relação entre as forças e deslocamentos na superfície do coração compõe a base estrutural. Focalizou-se, ainda, o papel do controle de força em relação `a posição da ferramenta do manipulador na superfície do coração. Pretende-se que a principal contribuição deste trabalho seja demonstrar que o controlador híbrido segue as restrições impostas pela dinâmica do sistema coração-pulmão. / This paper refers to the simulation of a control system for a robotic manipulator to compensate the movements of the heart in minimally invasive cardiac surgery. In order to compensate the motion of the beating heart techniques are used to implement a hybrid position/force controller based on data and the movements of the heart obtained in vivo, used as references to the input of the system. Topics modeling robotic manipulators, and in particular, modeling the relationship between forces and displacements on the surface of the heart comprises the structural basis. The role of power control over the position of the manipulator tool on the surface of the heart. It is intended that the main contribution of this study is to show that the hybrid controller follows the restrictions imposed by the dynamics of the heart-lung system.

Esta dissertação refere-se `a simulação de um sistema de controle em um manipulador robótico para compensação dos movimentos do coração em cirurgias cardíacas minimamente invasivas. No intuito de compensar os movimentos do batimento cardíaco utilizam-se técnicas de controle híbrido de posição/força e dados dos movimentos do coração obtidos in vivo, utilizadas como elementos básicos para a constituição deste sistema. Tópicos de modelagem de manipuladores robóticos e, em especial, a modelagem da relação entre as forças e deslocamentos na superfície do coração compõe a base estrutural. Focalizou-se, ainda, o papel do controle de força em relação `a posição da ferramenta do manipulador na superfície do coração. Pretende-se que a principal contribuição deste trabalho seja demonstrar que o controlador híbrido segue as restrições impostas pela dinâmica do sistema coração-pulmão. / This paper refers to the simulation of a control system for a robotic manipulator to compensate the movements of the heart in minimally invasive cardiac surgery. In order to compensate the motion of the beating heart techniques are used to implement a hybrid position/force controller based on data and the movements of the heart obtained in vivo, used as references to the input of the system. Topics modeling robotic manipulators, and in particular, modeling the relationship between forces and displacements on the surface of the heart comprises the structural basis. The role of power control over the position of the manipulator tool on the surface of the heart. It is intended that the main contribution of this study is to show that the hybrid controller follows the restrictions imposed by the dynamics of the heart-lung system.

The overall development of scientific and technical disciplines has enabled the introduction of minimally invasive surgical techniques in cardiac surgery practice. Implementation of minimally invasive cardiac surgery brings many positive effects for patients and healthcare. At the same time, however, it requires for the nurses to have appropriate knowledge, skills and experience to effectively provide comprehensive nursing care. The thesis is divided into theoretical and empirical parts. A total of four objectives were set. The first goal determines the specifics of nursing care of the patient before and after minimally invasive cardiac surgery. The second mapping the differences in nursing care in minimally invasive cardiac surgery from heart surgery classical approach. The third objective determines the role of nurses in patient awareness of minimally-invasive cardiac surgery. The fourth objective is focused on the needs and feelings of patients undergoing minimally invasive cardiac surgery. The results of qualitative research showed that preoperative and postoperative nursing care for minimally invasive cardiac surgery is similar to nursing care before and after cardiac surgery by standard median sternotomy approach. Nurses often wipe away differences associated with nursing care of standard and minimally invasive surgery, differences arose mainly after analysis of the data obtained. The differences include shorter hospital stay, shorter duration of mechanical ventilation, lower incidence of postoperative confusion, differences in invasive inputs, rehabilitation and awareness. For the majority of respondents from the ranks of the patients minimally invasive heart surgery technique had clearly positive impact on their mental condition.

Ce travail reprend les études d’évaluation d’une plateforme instrumentale dédiée à la chirurgie mitrale mini-invasive vidéo-assistée, et du télémanipulateur Da Vinci pour la réalisation d’anastomose mammaire interne / IVA à thorax fermé.) Evaluation du Portaclamp. Cette étude clinique a porté sur 20 patients opérés de chirurgie cardiaque sous CEC et a confirmé la simplicité d’utilisation du système, son efficacité et l’absence de morbidité ou complication induite. L’étude chez le porc des effets histologiques sur la paroi de l’aorte des trois clamps (l’endo-clamp, le clamp Chitwood et le Portaclamp) a révélé une atteinte majeure de l’endothélium aortique induite par l’endo-clamp . 2) Evaluation du Portapleg. Le Portapleg est un dispositif auto-suturant de cardioplégie antérograde constitué d’un clip en Nitinol restant implanté sur l’aorte. Une étude sur 20 patients a été rapportée avec comme critère principal le temps de saignement du site de ponction après injection de protamine. Le système a montré son efficacité hémostatique dans tous les cas sans événement secondaire. 3) Evaluation du Mitrax’s. C’est un cône en plastique polymère auto ajustable et auto expansible, qui repousse de façon symétrique et concentrique les parois de l’oreillette. Une étude prospective de son efficacité a été réalisée chez 62 patients opérés de chirurgie mitrale vidéo-assistée de façon consécutive. L’indice de satisfaction a été en moyenne 4.6, témoin d’une exposition optimale de la valve mitrale avec une vision endoscopique ou directe de la valve mitrale jugée excellente. 4) Analyse comparative des techniques mini-invasives de revascularisation de l’IVA par pontage mammaire (Port Access, MIDCAB, TECAB). Cette étude prospective a porté sur 160 patients ; à trois mois, le taux de réintervention sur l’IVA était : PA-CABG, 0% ; MIDCAB, 1.8% ; TECAB, 10% ; p<0.01. A trois ans, les taux actuariels de survie sans réintervention étaient : PA-CABG, 100% ; MIDCAB, 98±5 % ; TECAB, 88±8 % ; p<0.05. / This thesis is based on the evaluation studies of an instrumental platform dedicated to video assisted minimally invasive mitral valve surgery, and of the robotic Da Vinci system in LAD bypass with mammary artery in a closed chest approach. 1) Evaluation of Portaclamp. In 20 patients who underwent cardiac surgery with Portaclamp, a clinical study showed that the clamping system is safe, fast and easy and does not generate undue morbidity. In a pig model, severe lesions of the intima were observed on the clamping spot with the endoclamp, in comparison with Portaclamp and Chitwood clamp. 2) Evaluation of Portapleg. Portapleg is an auto-suturing system dedicated to antegrade cardioplegia delivery, and based on a Nitinol clip left implanted on the aorta. In 20 patients, the closure of the puncture aortic hole and the haemostasis after protamine were obtained in all cases. The procedure did not generate undue morbidity and there was no device-related adverse event. 3) Evaluation of Mitrax’s. The Mitrax’s retractor is a pattern cut polymer sheet, self-expanding and auto-adjusting. The effectiveness of Mitrax’s was evaluated in 62 patients who consecutively underwent a video-assisted mitral valve procedure. The global satisfaction index was 4.6±0.5, demonstrating the effectiveness of the device which provides optimal exposure and excellent direct vision. 4) Comparative analysis of minimally invasive techniques for LAD revascularization with mammary artery graft (Port Access, MIDCAB, TECAB). In a prospective study, 160 patients were included. At 3-month postoperatively, the end-point of LAD reintervention were PA-CABG, 0%; MIDCAB, 1.8%; TECAB, 10%; p=0.01. At 3-year, reintervention-free survival was significantly lower in the TECAB group: PA-CABG, 100% ; MIDCAB, 98±5 % ; TECAB, 88±8 % ; p<0.05.

of the dissertation Impact of minimally invasive approach on pulmonary function in patients undergoing aortic valve replacement MUDr. Ján Gofus The most common minimally invasive approach to aortic valve replacement is upper hemisternotomy, which has been implemented at our department, as well. Preserving the lower half of thoracic cage could lead to lower postoperative drop of pulmonary function, apart from other benefits. Nevertheless, publications on this topic are insufficient and controversial. Our aim was to perform a prospective randomized trial comparing upper hemisternotomy with standard (median) sternotomy in terms of pulmonary function changes perioperatively. We also added a novel exercise tolerance test, one-minute sit-to-stand test, and a quality of life evaluation to the study. We included patients indicated for elective isolated aortic valve replacement with bioprosthesis who were older than 65 years, signed informed consent, and in which both surgical approaches were technically feasible. Exclusion criteria were re-do surgery and concomitant cardiac surgery. Patients were randomized to minimally invasive and standard group in 1:1 ratio. On the day of admission, on the 7th postoperative day and 3 months postoperatively, the patients underwent pulmonary function testing and one-minute...