Feasibility of robotic telestenting over long geographic distances: a pre-clinical ex vivo and in vivo study

Madder, Ryan D.; VanOosterhout, Stacie; Mulder, Abbey; Bush, Jared; Martin, Samuel P.; Rash, Adam; Tan, Jose; Parker, Jessica; Li, Yao; Kottenstette, Nicholas; Bergman, Per; Nowak, Brent M.

doi:10.4244/eij-d-19-00106

Cited by 33 publications

(31 citation statements)

References 2 publications

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“…The CorPath GRX robot has been used in India to perform remote robot-assisted PCIs from 20 and >100 miles away 6 12. We hope that such application may be applied in the future for stroke treatment, in deprived remote areas.…”

Section: Discussionmentioning

confidence: 99%

Endovascular robotic: feasibility and proof of principle for diagnostic cerebral angiography and carotid artery stenting

Sajja

Sweid

Saiegh

et al. 2020

J NeuroIntervent Surg

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BackgroundRobots in surgery aid in performing delicate, precise maneuvers that humans, with inherent physical abilities, may be limited to perform. The CorPath 200 system is FDA approved and is being implemented in the US for interventional cardiology procedures. CorPath GRX robotic-assisted platform is the next-generation successor of CorPath 200.ObjectiveTo discuss the feasibility and early experience with the use of the CorPath GRX robotic-assisted platform for neuroendovascular procedures, including transradial diagnostic cerebral angiograms and transradial carotid artery stenting.MethodsThe cases of 10 consecutive patients who underwent neuroendovascular robotic-assisted procedures between December 1, 2019 and December 30, 2019, are presented.ResultsSeven patients underwent elective diagnostic cerebral angiography, and three patients underwent carotid artery angioplasty and stenting using the CorPath GRX robotic-assisted platform. All procedures were performed successfully, and no complications were encountered. Conversion to manual control occurred in three diagnostic cases because of a bovine arch that was previously not known. The fluoroscopy time and the procedure time continued to improve with subsequent procedures as we streamlined the workflow.ConclusionThis series demonstrates the early use of this technology. It could potentially be used in the near future for acute stroke interventions in remote geographic locations and in places where a neurointerventionalist is not available.

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Section: Discussionmentioning

confidence: 99%

Endovascular robotic: feasibility and proof of principle for diagnostic cerebral angiography and carotid artery stenting

Sajja

Sweid

Saiegh

et al. 2020

J NeuroIntervent Surg

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Section: Methodsmentioning

confidence: 99%

“…The Institutional Animal Care and Use Committee of the West Michigan Regional Laboratory (Grand Rapids, MI) approved the study protocol for the in vivo porcine model . All experiments were performed according to the committee's guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…An ex vivo model of telestenting was constructed using a robotic PCI system (CorPath GRX, Corindus Vascular Robotics, Waltham, MA) and a PCI simulator (ANGIO Mentor, Simbionix, Littleton, CO). 6 The simulator consisted of a mannequin with arterial access sites into which actual interventional devices, including guide catheters, coronary guidewires, and balloon catheters, were inserted. After insertion, subsequent manipulations of these devices, such as advancement, retraction, and torqueing, were detected by sensors in the simulator and displayed as corresponding movements of virtual devices within the endovasculature of a simulated patient on a bedside fluoroscopic monitor.…”

Section: Ex Vivo Modelmentioning

confidence: 99%

“…[1][2][3][4] One potential method to break down barriers to PCI access is the development of telestenting, defined as the performance of PCI using a combination of robotics and telecommunications by an operator in a separate geographic location from the patient. 5 In 2018, the feasibility of robotic telestenting was demonstrated in vivo in a porcine model over distances of >100 miles 6 and subsequently in humans over distances of approximately 20 miles. 7 Successful telestenting in these feasibility studies required the robotic drive and robotic control system to be connected over a network, yet the impact of network performance on telestenting remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Network latency and long‐distance robotic telestenting: Exploring the potential impact of network delays on telestenting performance

Madder

VanOosterhout

Mulder

et al. 2019

Cathet Cardio Intervent

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Objective: This study evaluated the impact of network latency on telestenting performance.Background: The feasibility of long-distance robotic telestenting was recently demonstrated, yet the impact of network performance on telestenting remains unknown.Methods: Ex vivo and in vivo telestenting models were constructed by connecting a robotic drive over a wired network to a robotic control system up to 103 miles away.During consecutive attempts to robotically wire a coronary artery, investigators randomly added signal latencies from 0 to 1,000 ms. Outcomes included wiring success, wiring time (time to advance wire to preselected target landmark), and perceived latency score (5 = imperceptible; 4 = noticeable but minor; 3 = noticeable; 2 = noticeable and major; 1 = unacceptable). Results:Wiring success was achieved in 95 of 95 attempts in the ex vivo model and in 57 of 57 attempts in vivo. No significant difference in wiring time was observed across added latencies from 0 to 1,000 ms in the ex vivo (p = .64) or in vivo (p = .40) models. Compared to an added latency of 0 ms, perceived latency scores were not significantly different for added latencies of 150 and 250 ms (p = NS for both), but were significantly lower for latencies ≥400 ms (p < .001).Conclusions: Added latencies up to 250 ms were not associated with perceived latency, but latencies ≥400 ms were perceptible. Based on these findings, future telestenting studies should utilize networks with latencies ≤250 ms if perceived latency is to be avoided.

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Robotic telestenting performance in transcontinental and regional pre‐clinical models

Madder

VanOosterhout

Parker

et al. 2020

Cathet Cardio Intervent

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Objectives This study was conducted to evaluate the association of geographic distance with robotic telestenting performance by comparing performance measures in transcontinental and regional pre‐clinical models of telestenting. Background Robotic telestenting, in which percutaneous coronary intervention (PCI) is performed on a remotely located patient, might improve PCI access, but has not been attempted over vast distances likely required to reach many underserved regions. Methods Telestenting performance was compared in regional (Boston to New York [206 miles]) and transcontinental (Boston to San Francisco [3,085 miles]) ex vivo models of telestenting, wherein a physician in Boston attempted robotic PCI on endovascular simulators in New York and San Francisco, respectively. PCI was attempted over both wired and fifth generation (5G)‐wireless networks. Outcome measures included procedural success, procedural time, and perceived latency. Results Procedural success was achieved in 20 consecutive target lesions in the regional model and in 16 consecutive target lesions in the transcontinental model. The transcontinental model had a greater latency than the regional model over both wired (121.5 ± 2.4 ms vs. 67.8 ± 0.9 ms; p < .001) and 5G‐wireless networks (162.5 ± 1.1 ms vs. 86.6 ± 0.6 ms; p < .001), but perceived latencies were graded “imperceptible” in all cases in both models. Transcontinental and regional models did not have significantly different procedural times over wired (4.1 ± 1.9 min vs. 9.0 ± 7.1 min; p = .051) or 5G‐wireless (3.0 ± 0.6 vs. 6.3 ± 1.2; p = .36) networks. Conclusions Transcontinental robotic manipulation of coronary devices is now possible and was not associated with adverse performance compared to robotic telestenting conducted regionally.

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Feasibility of robotic telestenting over long geographic distances: a pre-clinical ex vivo and in vivo study

Cited by 33 publications

References 2 publications

Endovascular robotic: feasibility and proof of principle for diagnostic cerebral angiography and carotid artery stenting

Endovascular robotic: feasibility and proof of principle for diagnostic cerebral angiography and carotid artery stenting

Network latency and long‐distance robotic telestenting: Exploring the potential impact of network delays on telestenting performance

Robotic telestenting performance in transcontinental and regional pre‐clinical models

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