A robotic surgical system that utilizes an endoscopic approach to achieve transmyocardial revascularization (TMR) can reduce patient hospitalization and recovery time.

The Port Enabled Angina Relief using Laser (PEARL) system is intended for endoscopic TMR in patients with advanced coronary artery disease. The system consists of a flexible fiberoptic hand-piece that delivers precise bursts of holmium:YAG laser energy directly to an area of ischemic myocardium. The handpiece is equipped with an extended length shaft, which can be introduced via a laparoscopic approach under general anesthesia. The distal end of the shaft is flexible, and is designed to enable the grasping and manipulation of the tip by surgical robotic tools, enabling precise target area placement. Once in the proper position, the handpiece control is used to create a series of laser channels approximately one-millimeter in diameter. During a typical procedure, approximately 20 - 35 channels are made in the heart muscle; 6-10 pulses are needed to transverse the myocardium and create the channels.

The outside punctures seal over with little blood loss while the new channels allow fresh blood to perfuse the heart wall immediately, and may provide oxygen in the process. How TMR actually reduces angina is not fully understood. Researchers speculate that the laser may stimulate angiogenesis, or that it may destroy nerve fibers to the heart, making patients unable to feel their chest pain. Angina usually subsides with improved oxygen supply to the damaged areas of heart muscle. The PEARL is a product of Cardiogenesis (Irvine, CA, USA), and has been approved by the [U.S.] Food and Drug Administration (FDA).

TMR is indicated in patients whose chronic angina symptoms are not relieved by medication and who are not candidates for percutaneous coronary intervention or coronary artery bypass graft (CABG) surgery.

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