Impact of network performance on remote robotic-assisted endovascular interventions in porcine model

Legeza, Peter; Britz, Gavin W.; Alpesh, Shah; Sconzert, Kalyna; Sungur, John Michael; Chinnadurai, Ponraj; Sinha, Kavya; Lumsden, Alan B.

doi:10.1007/s11701-021-01196-6

Cited by 9 publications

(7 citation statements)

References 10 publications

(15 reference statements)

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“…Other important aspects to consider for future platforms include improved quality of audio communication using multiuser, wireless headsets and a standardized communication framework during remote procedures. These findings correlate with recent publications on remote interventions, 15,18 although there are multiple challenges to overcome in the field of remote stroke treatment. 17,19,20 From a technical standpoint, a triaxial or quad-axial system (guiding sheath, catheter, microcatheter, and wire/stentriever) is needed to achieve fully robotic MT, and longer rapid-exchange devices are needed to facilitate aspiration thrombectomy.…”

Section: Discussionsupporting

confidence: 89%

“…The robotic system setup was described in detail previously. 14,15 The robotic drive was mounted onto the hybrid operating room table, then a robotic cassette was connected to the robotic arm and positioned above the chest and abdomen of the cadaver. The robotic cassette is compatible with a 0.014-inch wire and monorail/rapid exchange devices.…”

Section: Local and Remote Robotic Setupmentioning

confidence: 99%

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Transcarotid access for remote robotic endovascular neurointerventions: a cadaveric proof-of-concept study

Berczeli

Chinnadurai

Legeza

et al. 2022

Neurosurgical Focus

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OBJECTIVE The purpose of this proof-of-concept study was to demonstrate the setup and feasibility of transcarotid access for remote robotic neurointerventions in a cadaveric model. METHODS The interventional procedures were performed in a fresh-frozen cadaveric model using an endovascular robotic system and a robotic angiography imaging system. A prototype remote, robotic-drive system with an ethernet-based network connectivity and audio-video communication system was used to drive the robotic system remotely. After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter combination was modified to account for the “workable” length with the CorPath GRX robotic system using transcarotid access. RESULTS To simulate a carotid stenting procedure, a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery. After confirming the wire position and anatomy by angiography, a self-expandable rapid exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra Inc.) was loaded into the robotic cassette and positioned. After robotic retraction of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire X, Medtronic). The stentriever was then advanced robotically into the end of the microcatheter. After robotic unfolding and short microcatheter retraction, the microcatheter was manually removed and the stent retriever was extracted using robotic assistance. During intravascular navigation, the device position was guided by 2D angiography and confirmed by 3D cone-beam CT angiography. CONCLUSIONS In this proof-of-concept cadaver study, the authors demonstrated the setup and technical feasibility of transcarotid access for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical thrombectomy. Using transcarotid access, catheter length modifications were necessary to achieve “working length” compatibility with the current-generation CorPath GRX robotic system. While further improvements in dedicated robotic solutions for neurointerventions and next-generation thrombectomy devices are necessary, the transcarotid approach provides a direct, relatively rapid access route to the brain for delivering remote stroke treatment.

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Section: Discussionsupporting

confidence: 89%

Section: Local and Remote Robotic Setupmentioning

confidence: 99%

Transcarotid access for remote robotic endovascular neurointerventions: a cadaveric proof-of-concept study

Berczeli

Chinnadurai

Legeza

et al. 2022

Neurosurgical Focus

Self Cite

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“…Telesurgery has been performed in Spain, Italy, Germany, and China with promising results. Studies have also determined that a < 400 ms lag time of imperceptible to the surgeon, and this can be attained by the use of 5G networks [ 72 , 73 ]. Remote nephrotomy was also performed with a median distance of 187km between the patient and surgeon without any conversion and complication.…”

Section: Reviewmentioning

confidence: 99%

Robotic Revolution in Surgery: Diverse Applications Across Specialties and Future Prospects Review Article

Fairag,

Almahdi,

Siddiqi

et al. 2024

Cureus

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Robotic technology has transformed the field of surgery significantly. Since its inception in the 1970s, robotic surgery has advanced tremendously. The utilization of robotic systems, such as the da Vinci Surgical System, has become increasingly prevalent in minimally invasive procedures. These interventions offer enhanced precision, dexterity, and visualization. In general surgery, robotics has facilitated complex procedures, leading to reduced morbidity and shorter hospital stays. In urology, the robotic platform has revolutionized prostatectomies and other intricate interventions, demonstrating superior outcomes compared to traditional approaches. Orthopedic surgery has embraced robotics for precise joint replacements and spinal procedures. In pediatric surgery, the application of robotics has enabled intricate surgeries with reduced invasiveness and faster recovery times. Furthermore, the integration of artificial intelligence with robotic systems has paved the way for personalized treatment plans and data-driven decision-making. Despite these advancements, challenges such as cost and training persist. As robotic technology continues to evolve, its potential applications extend beyond current boundaries. This review aims to provide insights into the multifaceted impact of the robotic revolution in surgery and the exciting possibilities that lie ahead.

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“…Of the roughly 110,000 samples taken, only 17 were found to be over 400 ms. Therefore, nearly all of the data points will have little-to-no effect on performance [27]. If the user has some tolerance for the very rare delay spike, it may be acceptable.…”

Section: Delay and Time Measurementmentioning

confidence: 99%

MSK-TIM: A Telerobotic Ultrasound System for Assessing the Musculoskeletal System

Ochitwa,

Fotouhi,

Adams

et al. 2024

Sensors

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The aim of this paper is to investigate technological advancements made to a robotic tele-ultrasound system for musculoskeletal imaging, the MSK-TIM (Musculoskeletal Telerobotic Imaging Machine). The hardware was enhanced with a force feedback sensor and a new controller was introduced. Software improvements were developed which allowed the operator to access ultrasound functions such as focus, depth, gain, zoom, color, and power Doppler controls. The device was equipped with Wi-Fi network capability which allowed the master and slave stations to be positioned in different locations. A trial assessing the system to scan the wrist was conducted with twelve participants, for a total of twenty-four arms. Both the participants and radiologist reported their experience. The images obtained were determined to be of satisfactory quality for diagnosis. The system improvements resulted in a better user and patient experience for the radiologist and participants. Latency with the VPN configuration was similar to the WLAN in our experiments. This research explores several technologies in medical telerobotics and provides insight into how they should be used in future. This study provides evidence to support larger-scale trials of the MSK-TIM for musculoskeletal imaging.

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Impact of network performance on remote robotic-assisted endovascular interventions in porcine model

Cited by 9 publications

References 10 publications

Transcarotid access for remote robotic endovascular neurointerventions: a cadaveric proof-of-concept study

Transcarotid access for remote robotic endovascular neurointerventions: a cadaveric proof-of-concept study

Robotic Revolution in Surgery: Diverse Applications Across Specialties and Future Prospects Review Article

MSK-TIM: A Telerobotic Ultrasound System for Assessing the Musculoskeletal System

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