Computer assisted pericardial puncture: work in progress.

Until now, computer assisted surgery has focused primarily on surgical procedures involving rigid anatomical structures. Because soft tissues can be highly mobile and deformable, they may require specific imaging devices, suitable modeling tools, and guiding systems. Percutaneous pericardial puncture is a good clinical target for computer assisted surgery; this procedure is often performed without direct visualization and is dangerous even though echographic control is used. Computer assistance can greatly improve this technique and will allow accurate puncture of preplanned targets. This paper describes a new approach for computer assisted pericardial punctures (CASPER) and describes a first feasibility analysis of CASPER demonstrated with anesthetized animals. The approach is based on the use of echographic data localized in space, from which an optimal strategy is defined. Because of the specificity of the pericardial effusion, a stable target can be selected despite the heart motions. A passive guiding system is used. We have demonstrated the feasibility of the approach.