Report on Replacement of Heart bypass surgery by NAnorobots

Replacement of Bypass Surgery by Nanorobots

1. INTRODUCTION

The heart bypass surgery reroutes the blood supply around clogged arteries to
improve blood flow and oxygen to the heart. The arteries that bring blood to the heart
muscle (coronary arteries) become clogged by plaque (a buildup of fat, cholesterol
and other substances). This can slow or stop blood flow through the heart's blood
vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart
muscle can relieve chest pain and reduce the risk of heart attack. So the surgeons go
for this surgery by taking a segment of a healthy blood vessel from another part of the
body usually from leg and make a detour around the blocked part of the coronary
artery. The surgery involves an incision in the middle of the chest and separation of
the breastbone and after detouring, the breastbone is joined using wire and the
incision is sewed. The entire surgery can take 4-6 hours. After the surgery, the patient
is taken to the Intensive Care Unit. For a few days after the surgery, the patient is
connected to monitors and tubes.

Patient may experience side effects such as:

• Loss of appetite, constipation.

• Swelling in the area from which the segment of blood vessel was removed.

• Fatigue, mood swings, feelings of depression, difficulty in sleeping.

• Muscle pain or tightness in the shoulders and upper back.

The incision in the chest or the graft site (if the graft was from the leg or arm) can be
itchy, sore, numb, or bruised. The surgery may also lead to loss of memory and mental
clarity. To overcome all these problems that are involved in the bypass surgery, a nanorobot
is used, which can replace this techniques efficiently and effectively. This nanorobot will
remove the clot without any surgical procedure. Just a small incision is made into the femoral
artery to insert this Nanorobot, from where it is moved to the site of the plaque by the use of
its nano components that are attached to it.

Department of Biomedical engineering
KLE Dr.M.S.Sheshgiri College of Engineering and Technology Page 1

Replacement of Bypass Surgery by Nanorobots

2. STRUCTURE OF THE HEART:

The heart is an amazing organ. It beats thousands of times each day, every day,
for the entire life. In the process, it pumps about 5 million gallons of blood through the
entire body. The human heart resembles the shape of an upside down pear. It is a
hollow muscle that pumps blood throughout the blood vessels by repeated, rhythmic
contractions. An adult human heart has a mass of between 250 and 350 grams and is
about the size of a fist. It is located anterior to the vertebral column and posterior to the
sternum. The heart is enclosed in a double-walled sac called the pericardium. It has
two leaflets, the superficial is called the parietal pericardium and the inner one is the
visceral pericardium. The outer wall of the human heart is composed of three layers.
The outer layer is called the epicardium, or visceral pericardium since it is also the
inner wall of the pericardium. The middle layer is called the myocardium and is
composed of cardiac muscle which contracts. The inner layer is called
the endocardium and is in contact with the blood that the heart pumps. The human
heart has four chambers, two superior atria and two inferior ventricles. The atria are the
receiving chambers and the ventricles are the discharging chambers.


Replacement of Bypass surgery by Nanorobots

2.1. BLOOD FLOW IN HEART:

The heart is a complex organ, using four chambers, four valves and multiple blood
vessels to provide blood to the body. The flow through the heart is equally complex, with
blood moving through the heart, then the lungs, before returning again to the heart.

Blood returns to the heart from the body via two large blood vessels, called the superior
vena cava and the inferior vena cava. This blood carries little oxygen, as it is returning
from the body where oxygen is used.

Fig. Circulation of Blood flow in Heart



The blood first enters the right atrium. It then flows through the tricuspid valve
into the right ventricle. When the heart beats, the ventricle pushes the blood through the
pulmonic valve into the pulmonic artery. This artery is unique. It is the only artery in the
human body that carries oxygen-poor blood.

The pulmonic artery carries blood to the lungs where it “picks up” oxygen, and
leaves the lungs and returns to the heart through the pulmonic vein. The blood enters the
left atrium, and then descends through the mitral valve into the left ventricle. The left
ventricle then pumps blood through the aortic valve, and into the aorta, the blood vessel
that leads to the rest of the body.

The valve at the top of each ventricle opens to allow it to fill, while the valve at the
bottom makes sure the blood doesn’t leak out. When the ventricle is full, the top valve
closes and the bottom valve opens. The ventricle squeezes the blood out forcefully
through the bottom valve. Essentially, the valves keep the blood flowing in the correct
direction through the heart.



3. BYPASS SURGERY AND ITS NEED:

Heart bypass surgery is used to treat heart disease when the coronary arteries are
blocked. The doctor treats the problem by giving the blood a new pathway to the heart.
Hence the name Bypass surgery. There are two main coronary arteries--the right coronary
artery and the left coronary artery. The right coronary artery splits off into two more
arteries, known as the right marginal artery and the posterior descending artery. The left
coronary artery splits into two additional arteries as well--the circumflex artery and the left
anterior descending artery. This makes six total arteries in the human heart.
If one of these outer arteries gets blocked, it causes a heart attack. A blockage like this is
normally caused by fatty deposits that build up in the heart's arteries over the course of
many years. When one of the heart's arteries gets blocked and a person has a heart attack,
one common procedure is to perform heart surgery and sew in a new piece of blood vessel
to bridge over (bypass) the blockage. In many cases, the surgeon will fix not only the
immediate problem, but also other arteries on the heart that are starting to look blocked.

In some cases, the surgeon can perform this operation while your heart is still beating.
This is called "off-pump" coronary bypass surgery.

Fig. Coronary artery Bypass graft



If the surgeon repairs three of the arteries, it is called a triple bypass. If four arteries are
repaired, it's a quadruple bypass. The blood vessel used to create the bypass is taken from
the chest or the leg as the body has several vessels that can be removed without doing
harm.

Arteriosclerosis is a common arterial disorder characterized by thickening, loss of
elasticity, and calcification of arterial walls, resulting in a decreased blood supply.
Atherosclerosis is a common arterial disorder characterized by yellowish plaques
of cholesterol, lipids, and cellular debris in the inner layer of the walls of large and
medium-sized arteries.



4. ROUTINE PROCEDURE OF BYPASSS SURGERY:

The patient is brought to the operating room and moved on to the operating table.
An anesthetist places a variety of intravenous lines and injects a painkilling agent followed
within minutes by an induction agent to render the patient unconscious.
An endotracheal tube is inserted and secured by the anesthetist and mechanical
ventilation is started. General anesthesia is maintained by a continuous very slow
injection.
The chest is opened via a median sternotomy and the heart is examined by the surgeon.
The bypass grafts are harvested – frequent conduits are the internal thoracic arteries, radial
arteries and saphenous veins. When harvesting is done, the patient is given heparin to
prevent the blood from clotting.
In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.
If the case is "on-pump", the surgeon sutures cannulae into the heart and instructs
the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the
surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to
deliver cardioplegia (a special potassium-mixture, cooled) to stop the heart and slow its
metabolism. Usually the patient's machine-circulated blood is cooled to around 84
°F (29 °C)
One end of each graft is sewn on to the coronary arteries beyond the blockages and the
other end is attached to the aorta.
The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In
cases where the aorta is partially occluded by a C-shaped clamp, the heart is restarted and
suturing of the grafts to the aorta is done in this partially occluded section of the aorta
while the heart is beating.
Chest tubes are placed in the mediastinal and pleural space to drain blood from around the
heart and lungs.
The sternum is wired together and the incisions are sutured closed.
The patient is moved to the intensive care unit (ICU) to recover.



Nurses in the ICU focus on recovering the patient by monitoring blood pressure, urine output
and respiratory status as the patient is monitored for bleeding through the chest tubes. If there
is a chest tube clogging, complication such as cardiac tamponade, pneumothorax or death can
ensue. Thus nurses closely monitor the chest tubes and undertake methods to prevent clogging
so bleeding can be monitored and complications can be prevented.

After awakening and stabilizing in the ICU (approximately one day), the person is
transferred to the cardiac surgery ward until ready to go home (approximately four days).



5. NANOROBOTS:

Nanorobots are theoretical microscopic devices measured on the scale of
nanometers (1nm equals one millionth of 1 millimeter). When fully realized from the
hypothetical stage, they would work at the atomic, molecular and cellular level to perform
tasks in both the medical and industrial fields. Nanomedicine’s nanorobots are so tiny that
they can easily traverse the human body. Scientists report the exterior of a Nanorobot will
likely be constructed of carbon atoms in a diamondoid structure because of its inert
properties and strength. Super-smooth surfaces will lessen the likelihood of triggering the
body's immune system, allowing the nanorobots to go about their business unimpeded.
Glucose or natural body sugars and oxygen might be a source for propulsion and the
Nanorobot will have other biochemical or molecular parts depending on its task.

5.1. ELEMENTS OF NANOROBOT:

Carbon will likely be the principal element comprising the bulk of a medical
Nanorobot, probably in the form of diamond or diamondoid/fullerene nano composites.
Many other light elements such as hydrogen, sulphur, oxygen, nitrogen, fluorine, silicon,
etc. will be used for special purposes in nanoscale gears and other components.
Morphological examination revealed no physical damage to either fibroblasts or
macrophages, and human osteoblast like cells confirming the biochemical indication that
there was no toxicity and that no inflammatory reaction was elicited in vitro. The
smoother and more flawless the diamond surface, the lesser is the leukocyte activity and
fibrinogen adsorption.

The exterior surface with near-nanometer smoothness results in very low bioactivity. Due
to the extremely high surface energy of the passivated diamond surface and the strong
hydrophobicity of the diamond surface, the diamond exterior is almost completely
chemically inert.



5.2. NANOROBOTS IN MEDICAL FIELD:

Nanomedicine is the medical application of nanotechnology. The approaches towards
nanomedicine range from the medical use of nonmaterial’s, to nanoelectronic biosensors,
and even possible future applications of molecular nanotechnology. Medical nanodevices
could augment the immune system by finding and disabling unwanted bacteria and
viruses. When an invader is identified, it can be punctured, letting its contents spill out and
ending its effectiveness. If the contents were known to be hazardous by themselves, then
the immune machine could hold on to it long enough to dismantle it more completely.

5.3. NANOROBOTS IN HEART SURGERY:

Heart blockings are occurring more and more. The most common methods of surgery for
heart attacks are By-Pass surgery and Angio Plaster. But these methods are risky and bring
several side-effects with them. Surgery with nanorobots is safer and the surgeon doesn’t
even have to touch the patient. Nanorobots as a heart surgeon could replace the
mentioned, current surgeries and thus manage the same result without the side effects. The
procedure would consist of locating and serving the block. After locating the blockade,
nanolasers could be used to tackle the block after getting conﬁrmation by the practitioners.



6. PROPERTIES OF THE NANOROBOT USED IN BYPASS

SURGERY:

The nanorobots structure will have two spaces that will consist of an interior and exterior.
The exterior of the nanorobot will be subjected to the various chemical liquids in our
bodies but the interior of the nanorobot will be a closed, vacuum environment into which
liquids from the outside cannot enter. A nanorobot will prevent itself, from being attacked
by the immune system by having a passive, diamond exterior. The diamond exterior will
have to be smooth and flawless to prevent Leukocytes activities since the exterior is
chemically inert and have low bioactivity. An electric motor is attached to this nanorobot
for its propagation inside the circulatory system in the blood vessels. The microprocessor,
artery thermometer, camera, rotating needle are also incorporated in this nanomachine,
which perform the vital role of the nanorobot. The microprocessor controls the overall
operation of this nanorobot .The radioactive material is impregnated and is made as a part
of the exterior surface, which helps us to trace the nanorobot at any period of time. The
magnetic switch is also provided to switch on and off the nanorobot at any point of time.

Fig. Nanorobot in blood cells



7. INTRODUCTION OF NANOROBOT IN TO THE BODY AND THE
SOURCE OF MOVING:

Nanorobot gets access into the body through a large diameter artery so that it may move
easily without being too destructive in the first place. This artery should be traversed
easily to gain access to most areas of the body in minimal time. The obvious candidate is
the femoral artery in the leg. This is in fact the normal access point to the circulatory
system for operations that require access to the bloodstream for catheters, dye injections,
etc.

Fig. Nanorobot and its structure



The circulatory system allows the device to move about. But to get access to the site of
operation of the nanorobot, it must have active propeller. Therefore, an electric motor is
used. This electric motor will have a shrouded blade design so as to avoid damage to the
surrounding tissues (and to the propellers) during the inevitable collisions. Long-range
sensors are used to navigate to the site of the plaque closely enough so that the use of
short-range sensors is practical. These sensors would be used during actual operations, to
allow the device to distinguish between healthy and unwanted tissue. A small amount of
radioactive substance is impregnated as part of the micro robot. This would allow its
position to be tracked throughout the body at all times. After reaching the site of location
the internal sensor is used to find out the exact location of the plaque and also by using TV
camera the plaque can be more precisely located. The area where the temperature exceeds
than the maximum limit set in the nanorobot, will be operated on by the Nanorobot i.e.
that part will be cut by the rotator needle attached to the nanorobot. A TV camera in the
device helps in transmitting the picture outside the body to a remote control station,
allowing the people operating the device to steer it and also to view the internal
environment of the circulatory system.



8. TREATMENT OF PLAQUE AND MEANS OF REMOVAL OF
NANOROBOT:
As the nanorobot detects the site of plaque using camera and thermometer, it will activate
the rotating needle. The diamond chipped burr grinds the plaque into micro particles,
which then travel harmlessly through the circulatory system and are eventually eliminated
by the body. Cutting procedure is monitored using the camera and care is taken that it will
not cut the surrounding tissue. This care is taken by the magnetic switch that has been
provided in it. Once the nanorobot has been inserted into the body, it starts the operation
only when a bar magnet is moved over it. This movement of magnet in one direction only
makes the magnetic switch in on condition, and the nanorobot becomes active. Hence if
any problem occurs during the task of removal of plaque and shutting of the nanorobot is
the only solution, then by making the magnetic switch off by moving the bar magnet again
will terminate all the running functions of this nanomachine .After the nanorobot has
removed the plaque, and its function is over, it has to be removed from the body. This can
be made possible by guiding the Nanorobot to anchor a blood vessel that is easily
accessible from outside, and perform a small surgical operation is performed to remove it.

Fig:A sample picture of the bypass surgery



9. SOURCE OF POWER FOR THE ROBOT:

The nuclear power is carried onboard to supply required amount of energy for the
operation of the device. This would be relatively easy to shield given the amount of fuel
involved, and it has other advantages as well. The same radioactive material could be used
for power and tracking, since the casing must be hotter than body temperature to produce
power and there would be no worries about running out of power, or insufficient power to
get the job done. At the micro scale, shielding and power conversion are relatively easy,
making this method extremely practical.

Fig:Sample image of a nanorobot inside the red blood cells.



10. ADVANTAGES AND DISADVANTAGES

ADVANTAGES:

The nanorobots do not generate any harmful activity as they work only in specific site as
told by the physician.
Rapid elimination of diseases.
Nanorobots might also reproduce copies of themselves to replace worn out unit, a process
called self replication.
The major advantage of Nanorobot is the durability which in theory is thought be for bout
decades and centuries.

DISADVANTAGES:

The Nanorobot should be very accurate otherwise harmful events may occur.
The initial design cost is very high.
The design of this robot is very complicated.
Hard to interface, customize and design.



CONCLUSION:

It is a proposed idea that can be made practical by the existing engineering technology.

a) The Nanorobot to be designed must be biocompatible.

b) The size of the Nanorobot should not be more than 3 micron so as, not to block any
capillary.

c) The Nanorobot should resist the corrosive environment of the blood vessels.

d) The nano particles that are attached to this Nanorobot should be held tightly and must
be durable.

With the application to healthcare, nanotechnology is indeed quite the exciting and
revolutionary technique in the pursuit of quality healthcare. Nanomedicine endeavors to
improve human health utilizing molecular tools and nano particles. The technology and
the applicability of it to the human body is still at preliminary stages



BIBLIOGRAPHY

 Replacement Of Heart Bypass Surgery By Nanorobots, International Journal Of
Advanced Research And technology, www.ijart.org/2012/IJART080.pdf ,Shinob
M.C, Department of ECE,Roever Engineering College,Perambalur Jidhin G,
Department of ECE,Roever Engineering College,Perambalur

 www.frost.com,www.frost.com/sublib/display-market-insightop.do?id=130393722
 Possibilitieswithnanorobotics,3407713mcfilmer.files.wordpress.com/2012/11/repo
rt-assignment-1.pdf
 123seminarsonly,123seminarsonly.com/Seminar-Reports/039/66242411-Nano-
Robots.pdf
 Discoveryhealth,health.howstuffworks.com/medicine/surgeriesprocedures/question
120.
 wiseGEEK, www.wisegeek.com/what-are-nanorobots.htm
 John Hopkins
medicine,www.hopkinsmedicine.org/heart_vascular_institute/clinical_services/spe
cialty_areas/coronary_artery_surgery.html


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