A Robotic System With Path Planning and Visual Guidance for Teleoperated Left Atrial Appendage Closure

Percutaneous Left Atrial Appendage Closure (LAAC) is a minimally invasive procedure to prevent thromboembolic events in atrial fibrillation patients. The procedure's success relies on precise navigation and occluder deployment, which is challenged by sheath movement in the dynamic cardiac environment, procedural complexity, and prolonged radiation exposure. This study introduces a robotic-assisted navigation system for LAAC procedure, integrating a dedicated steerable sheath, custom planning algorithms, and an intuitive teleoperation interface. The path-planning framework generates collision-free routes based on patient-specific anatomy, adjusting for deviations in real-time. The teleoperation interface comprises a digital replica of the patient's anatomy with real-time visual feedback to the user for precise and intuitive navigation. Bench-top validation demonstrated that navigation guidance reduced target position error by 2.03% with the planner and 2.85% with the replanner, compared to free navigation without planning assistance. Planning and replanning strategies also reduced collisions with cardiac structures, highlighting the platform's potential to improve procedural precision and safety.