Limitations for Manual and Telemanipulator-Assisted Motion Tracking - Implications for Endoscopic Beating-Heart Surgery

Stephan Jacobs, David Holzhey, Bob B. Kiaii, Joerg F. Onnasch, Thomas Walther, Friedrich W. Mohr, Volkmar Falk

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background. Surgical performance is limited by human factors. Beating-heart surgery requires full dexterity and motion tracking. Currently techniques for total endoscopic beating-heart bypass grafting using telemanipulation systems are being developed. The aim of this study was to assess the limitations for manual and telemanipulator-assisted motion tracking using the da Vinci telemanipulator system. Methods. To simulate beating-heart conditions an endoscopic trainer was developed. Twenty subjects were asked to touch targets manually and with telemanipulator assistance with different patterns of increasing index of difficulty (resting model, unstabilized, and stabilized model with a frequency of 35, 60, and 90 beats per minute). In addition one task was performed using different scaling ratios on a resting model. The times between hits as well as errors were electronically recorded. Results. There was no significant impact of various frequencies and amplitudes for manual tracking. The average values for the delay (km[ms]) and information-processing (cm [ms/bit]) constants for the manual tasks were 201 ms and 86 ms/bit respectively. Both the delay constant (kt = 630 ms; p < 0.0005) and the information-processing constant (ct = 250 ms/bit; p < 0.0005) were increased for the telemanipulator-assisted tasks at rest. When working on moving targets telemanipulator-assisted tracking required significantly more time and led to more errors. At a frequency of 90 beats per minute telemanipulator-assisted tracking became more difficult. Conclusions. Endoscopic beating-heart bypass grafting requires optimal stabilization to avoid inaccuracies due to incomplete motion tracking. At higher frequencies telemanipulator-assisted tracking became more difficult, demonstrating the technical limits of current telemanipulator technology.

Original languageEnglish (US)
Pages (from-to)2029-2035
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number6
StatePublished - Dec 2003
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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