The Development of Robotic Technology in Cardiac and Vascular Interventions

Pourdjabbar, Ali; Ang, Lawrence; Reeves, Ryan; Patel, Mitul; Mahmud, Ehtisham

doi:10.5041/rmmj.10291

Cited by 17 publications

(8 citation statements)

References 39 publications

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“…These cassettes allow the use of microcatheters guided by a microwire routinely utilized in CV procedures. 19 The first animal feasibility study for CV intervention in intracranial vessels was carried in 2020 by Britz et al in a porcine model. He demonstrated the successful navigation, wiring, and deployment of stents and coils without complications.…”

Section: Discussionmentioning

confidence: 99%

Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

et al. 2022

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Introduction Robotics could expand treatment of rapidly progressive pathologies such as acute ischemic stroke, with the potential to provide populations in need prompt access to neuro-endovascular procedures. Methods Robotically-assisted (RA) neuro-endovascular procedures (RANPs) performed at our institution were retrospectively examined (RA-group, RG). A control group of manual neuro-endovascular procedures was selected (manual group, MG). Total operating room (OR) time, procedural time, contrast media use, fluoroscopy time, conversion from RA to manual control, procedural success, and complication rates were compared. A learning curve was identified. Results Forty-one (41) RANPs were analyzed. Ages ranged from 20–82 y.o. Indications included diagnostic cerebral angiography (37), extracranial carotid artery stenting (3), and transverse sinus stent (1). Total OR time was longer in RG (median 86 vs. 71 min, p < 0.01). Procedural time (median 56 vs. 45 min, p = 0.12), fluoroscopy time (median 12 vs. 12 min, p = 0.69) and contrast media usage (82 vs. 92 ml, p = 0.54) were not significantly different. Patient radiation exposure was similar, considering similar fluoroscopy times. Radiation exposure and lead apron use were virtually absent for the main surgeon in RG. Procedural success was 83% and conversion from RA to manual control was 17% in RG. No treatment-related complications occurred. A learning curve showed that, after the fifth procedure, procedural times reduced and stabilized. Conclusions This series may contribute to further demonstrating the safety and feasibility of RANPs. RANPs can potentially reduce radiation exposure and physical burden for health personnel, expand acute cerebrovascular treatment to underserved areas, and enhance telementoring. Prospective studies are necessary for results to be generalized.

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Section: Discussionmentioning

confidence: 99%

Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

et al. 2022

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“…Overall, the robotic system is compact and could facilitate simplified manipulation of endovascular tools through the control work station; in addition, the drive cassette is a sterile disposable part that can be easily sterilized. However, the disadvantages are that it can only operate one set of guidewire and catheters, which is not fully capable for treating complex lesions, coupled with the high cost of consumables and the lack of distal force feedback [ 117 , 118 ]. The Hansen Magellan TM Robotic system is a remotely steerable catheter system that is based largely on the original Sensei ® system but with significant modifications.…”

Section: Key Technologies and Application Areas Of Vascular Intervent...mentioning

confidence: 99%

Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review

Duan

Akinyemi

et al. 2023

Micromachines

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Prior methods of patient care have changed in recent years due to the availability of minimally invasive surgical platforms for endovascular interventions. These platforms have demonstrated the ability to improve patients’ vascular intervention outcomes, and global morbidities and mortalities from vascular disease are decreasing. Nonetheless, there are still concerns about the long-term effects of exposing interventionalists and patients to the operational hazards in the cath lab, and the perioperative risks that patients undergo. For these reasons, robot-assisted vascular interventions were developed to provide interventionalists with the ability to perform minimally invasive procedures with improved surgical workflow. We conducted a thorough literature search and presented a review of 130 studies published within the last 20 years that focused on robot-assisted endovascular interventions and are closely related to the current gains and obstacles of vascular interventional robots published up to 2022. We assessed both the research-based prototypes and commercial products, with an emphasis on their technical characteristics and application domains. Furthermore, we outlined how the robotic platforms enhanced both surgeons’ and patients’ perioperative experiences of robot-assisted vascular interventions. Finally, we summarized our findings and proposed three key milestones that could improve the development of the next-generation vascular interventional robots.

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“…Since the principal radiation protection measures and shielding used during endovascular interventions performed in the angiography suite are mostly operatordependent [5,6], the inclusion of a joystick-operated robotic device is a protective factor, as interventionalists will be able to operate from a safe distance in regard to the exposure of dispersed radiation. In comparison to merely skilled human performance, robotic systems have the advantage to assist navigation accuracy, dexterity, and speed [7] When it comes to delivering devices and manipulating catheters during robotic-assisted endovascular procedures, the early generation of devices required dedicated catheters (robotic catheters) and high-pro le sheaths, which limit the practicality and increases the cost of consumables, especially in more complicated procedures [8,9]. Newer generation vascular system technologies have undergone further technological development making possible to use off-theshelf products, which makes them more appealing and accessible, laying the groundwork for the establishment of telemedicine and telementoring programs.…”

Section: Bachgroundmentioning

confidence: 99%

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

Moschovaki-Zeiger,

Arkoudis,

Spiliopoulos

2023

Preprint

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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 catheterization 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 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 catheterization, were evaluated, and recorded. Results All pre-determined arteries were successfully catheterized (100% technical success), by both operators. No angiographic acute complications occurred. The catheters 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 126 ± 51 seconds. 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 Development of Robotic Technology in Cardiac and Vascular Interventions

Cited by 17 publications

References 39 publications

Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review

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

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