Preclinical study testing feasibility and technical requirements for successful telerobotic long distance peripheral vascular intervention

Legeza, Peter; Sconzert, Kalyna; Sungur, John Michael; Loh, Thomas M.; Britz, Gavin W.; Lumsden, Alan B.

doi:10.1002/rcs.2249

Cited by 8 publications

(5 citation statements)

References 14 publications

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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%

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%

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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“…As an additional advantage, the option to perform the interventions in sitting position throughout the procedure, would most probably lessen the impact that standing for lengthy periods of time with heavy equipment has on the body. Moreover, remotely controlled platforms are being developed so that operators may be located in large geographical distance from their patients, enabling for the delivery of procedures and skills to be carried out in facilities without an experienced endovascular professional [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and feasibility study of a novel robotic system in an in vivo porcine vascular model

Moschovaki-Zeiger,

Arkoudis,

Spiliopoulos

2024

CVIR Endovasc

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Purpose The goal of this preclinical study is to assess the functionality, technical feasibility, and safety of a new vascular robotic LIBERTYR 3 System, in the microcatheterization of vascular targets using a range of guidewires and microcatheters. Material and methods An anesthetized pig served as an arterial model for the robotic device (LIBERTYR3; Microbot Medical Ltd, Yoqneam, IL). The primary efficacy endpoint was the evaluation of its capability to selectively catheterize predetermined distal arterial branches in the liver, kidneys, and mesenteric arteries (technical success), under fluoroscopy guidance. The primary safety endpoint was the occurrence of angiographic acute catheterization-related complications (dissection, thrombosis, embolism, perforation). The catheterizations were conducted by two interventional radiologists that present different work experience in endovascular procedures (18 and 2 years respectively), using a variety of microcatheters and wires. Various procedural parameters such as functionality, practicality, ease of use, and time required for selective catheterization, were evaluated, and recorded. Results All pre-determined arteries were successfully selectively catheterized (100% technical success), by both operators. No angiographic acute complications occurred. The microcatheters and wires were manipulated using the remote portable console in an effortless manner that maintained a high level of accuracy. Mean time for selective catheterization was 131 ± 82 s. The robot's conversion function to manual operation was successfully demonstrated. Conclusion Robotic navigation and catheterization of selected target arteries were accomplished without observable vascular damage, suggesting that the LIBERTYR 3 robotic system is a reliable and safe tool for robotic-assisted endovascular navigation. Further experimental studies are required to evaluate safety and efficacy prior to introduction into clinical practice.

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“…The world’s first telesurgery, named “Operation Lindbergh,” was conducted in 2001 between a team of French surgeons in New York, USA, and a female patient in Strasbourg, France, using a ZEUS robotic system [ 55 ]. Further clinical studies have demonstrated its feasibility in interventional cardiology in vivo and in vitro in interventional vascular surgery so far [ 56 – 58 ].…”

Section: Telesurgerymentioning

confidence: 99%

“…The major challenges are the latency time, delaying audible and visual signals, thus resulting in surgical inaccuracy and a risk of the patient’s safety. A stable high-speed-data connection is necessary throughout the procedure [ 56 ]. Furthermore, financial and legal issues of remote surgical procedures between different medical centers have to be taken into consideration.…”

Section: Telesurgerymentioning

confidence: 99%

Robot-assisted techniques in vascular and endovascular surgery

Püschel

Schafmayer

Groß

2022

Langenbecks Arch Surg

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For thousands of years, robots have inspired the imagination of humans, but it was only about 35 years ago that a robot was used for the first time in medicine. Since then, robot-assisted procedures have become increasingly popular in urology, general surgical specialties, and gynecology. Robot-assisted vascular surgery was first introduced in 2002 and was thought to overcome the limitations of laparoscopy. However, it did not gain widespread popularity, and its usage is still limited to a few centers worldwide. Robot-assisted endovascular procedures, on the other hand, while still in its infancy, have become a promising alternative to existing techniques. The improvements of the robotic systems promote better surgical performance and reduce occupational hazards for vascular and endovascular surgeons. A comprehensive review of literature was performed using the search terms “robotic,” “robot assisted,” “vascular surgery,” and “aortic” for surgical procedures or “robotic,” “robot assisted,” and “endovascular” for endovascular procedures. Full text articles that were published between January 1990 and March 2021 were included. This review summarizes the development of the techniques for robot-assisted vascular and endovascular surgery in recent years, its outcomes, advantages, disadvantages, and perspectives.

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Preclinical study testing feasibility and technical requirements for successful telerobotic long distance peripheral vascular intervention

Cited by 8 publications

References 14 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

Safety and feasibility study of a novel robotic system in an in vivo porcine vascular model

Robot-assisted techniques in vascular and endovascular surgery

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