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Hamady M. Performance Evaluation of a Miniature and Disposable Endovascular Robotic Device. Cardiovasc Intervent Radiol 2024; 47:1023-1024. [PMID: 38772938 DOI: 10.1007/s00270-024-03742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/23/2024]
Affiliation(s)
- M Hamady
- Department of Surgery and Cancer, Imperial College-London, London, UK.
- Queen Elizabeth Queen Mother Wing-St Mary's Hospital, Paddington, London, W2 1NY, UK.
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Morag E, Cornelis FH, Weisz G, Gandhi R. Overcoming Barriers and Advancements in Endovascular Robotics: A Review of Systems and Developments. Tech Vasc Interv Radiol 2023; 26:100918. [PMID: 38071030 DOI: 10.1016/j.tvir.2023.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Endovascular robots have the potential to revolutionize the field of vascular interventions by enhancing procedural efficiency, accuracy, and standardization. They aim to reduce radiation exposure, as well as physical strain on operators and medical staff, while enabling precise navigation of catheters through challenging anatomical structures. However, the widespread adoption of these robots faces barriers, such as real estate constraints, setup time, limited range of compatible tools, and high costs. This paper discusses these barriers and highlights Hansen Medical's Magellan and the Liberty robotic systems as notable examples. New developments will offer cost-effective, intuitive, and disposable approaches to endovascular procedures. Despite challenges, endovascular robots hold promise for improving access to endovascular therapy and transforming patient care in various healthcare settings.
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Affiliation(s)
- Eyal Morag
- Department of Radiology, Yokneam Illit, Israel.
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Weill Cornell Medical College, New York, NY
| | - Giora Weisz
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Ripal Gandhi
- Department of Radiology, Miami Cardiac and Vascular Institute, FIU Herbert Wertheim College of Medicine, Miami Beach, FL
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The Utility of Multimodal Imaging and Artificial Intelligence Algorithms for Overlying Two Volumes in the Decision Chain for the Treatment of Complex Pathologies in Interventional Neuroradiology—A Case Series Study. Life (Basel) 2023; 13:life13030784. [PMID: 36983938 PMCID: PMC10058421 DOI: 10.3390/life13030784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/26/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
3D rotational angiography is now increasingly used in routine neuroendovascular procedures––in particular, for situations where the analysis of two overlayed sets of volume imaging proves useful for planning the treatment strategy or for confirming the optimal apposition of the intravascular devices used. The aim of this study is to identify and describe the decision algorithm for which the overlay function of 3D rotational angiography volumes, high-resolution contrast-enhanced flat panel detector CT adapted for intravascular devices (VasoCT/DynaCT), non-enhanced flat detector C-arm volume acquisition functionality integrated with the angiography equipment (XperCT/DynaCT), and isovolumetric MRI volumes were all used in treatments performed in a series of 29 patients. Two superposed 3DRA volumes were used in the treatment aneurysms located at the junction of two vascular territories and for arteriovenous malformations with compartments fed from different vascular territories. The superposition function of a preoperatively acquired 3DRA volume and a postoperatively acquired VasoCT volume provides accurate information about the apposition of neuroendovascular endoprostheses used in the treatment of aneurysms. The automatic overlay function generated by the 3D workstation is particularly useful, but in about 50% of cases it requires manual operator-dependent correction, requiring a certain level of experience. In our experience, multimodal imaging brings an important benefit, both in the treatment decision algorithm and in the assessment of neuroendovascular treatment efficacy.
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Klaassen J, Vijn LJ, Hazenberg CEVB, van Herwaarden JA. New tools to reduce radiation exposure during aortic endovascular procedures. Expert Rev Cardiovasc Ther 2022; 20:567-580. [PMID: 35726665 DOI: 10.1080/14779072.2022.2092096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The evolution of endovascular surgery over the past 30 years has made it possible to treat increasingly complex vascular pathologies with an endovascular method. Although this generally speeds up the patient's recovery, the risks of health problems caused by long-term exposure to radioactive radiation increase. This warrants the demand for radiation-reducing tools to reduce radiation exposure during these procedures. AREAS COVERED For this systematic review Pubmed, Embase and Cochrane library databases were searched on 28 December 2021 to provide an overview of tools that are currently used or have the potential to contribute to reducing radiation exposure during endovascular aortic procedures. In addition, an overview is presented of radiation characteristics of clinical studies comparing a (potential) radiation-reducing device with conventional fluoroscopy use. EXPERT OPINION Radiation-reducing instruments such as fiber optic shape sensing or electromagnetic tracking devices offer the possibility to further reduce or even eliminate the use of radiation during endovascular procedures. In an era of increasing endovascular interventional complexity and awareness of the health risks of long-term radiation exposure, the use of these technologies could have a major impact on an ongoing challenge to move toward radiation-free endovascular surgery.
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Affiliation(s)
- Jurre Klaassen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linde J Vijn
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Crinnion W, Jackson B, Sood A, Lynch J, Bergeles C, Liu H, Rhode K, Mendes Pereira V, Booth TC. Robotics in neurointerventional surgery: a systematic review of the literature. J Neurointerv Surg 2022; 14:539-545. [PMID: 34799439 PMCID: PMC9120401 DOI: 10.1136/neurintsurg-2021-018096] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Robotically performed neurointerventional surgery has the potential to reduce occupational hazards to staff, perform intervention with greater precision, and could be a viable solution for teleoperated neurointerventional procedures. OBJECTIVE To determine the indication, robotic systems used, efficacy, safety, and the degree of manual assistance required for robotically performed neurointervention. METHODS We conducted a systematic review of the literature up to, and including, articles published on April 12, 2021. Medline, PubMed, Embase, and Cochrane register databases were searched using medical subject heading terms to identify reports of robotically performed neurointervention, including diagnostic cerebral angiography and carotid artery intervention. RESULTS A total of 8 articles treating 81 patients were included. Only one case report used a robotic system for intracranial intervention, the remaining indications being cerebral angiography and carotid artery intervention. Only one study performed a comparison of robotic and manual procedures. Across all studies, the technical success rate was 96% and the clinical success rate was 100%. All cases required a degree of manual assistance. No studies had clearly defined patient selection criteria, reference standards, or index tests, preventing meaningful statistical analysis. CONCLUSIONS Given the clinical success, it is plausible that robotically performed neurointerventional procedures will eventually benefit patients and reduce occupational hazards for staff; however, there is no high-level efficacy and safety evidence to support this assertion. Limitations of current robotic systems and the challenges that must be overcome to realize the potential for remote teleoperated neurointervention require further investigation.
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Affiliation(s)
- William Crinnion
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Ben Jackson
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Avnish Sood
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jeremy Lynch
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Christos Bergeles
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Hongbin Liu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Thomas C Booth
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
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Bravo J, Wali AR, Hirshman BR, Gopesh T, Steinberg JA, Yan B, Pannell JS, Norbash A, Friend J, Khalessi AA, Santiago-Dieppa D. Robotics and Artificial Intelligence in Endovascular Neurosurgery. Cureus 2022; 14:e23662. [PMID: 35371874 PMCID: PMC8971092 DOI: 10.7759/cureus.23662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/05/2022] Open
Abstract
The use of artificial intelligence (AI) and robotics in endovascular neurosurgery promises to transform neurovascular care. We present a review of the recently published neurosurgical literature on artificial intelligence and robotics in endovascular neurosurgery to provide insights into the current advances and applications of this technology. The PubMed database was searched for "neurosurgery" OR "endovascular" OR "interventional" AND "robotics" OR "artificial intelligence" between January 2016 and August 2021. A total of 1296 articles were identified, and after applying the inclusion and exclusion criteria, 38 manuscripts were selected for review and analysis. These manuscripts were divided into four categories: 1) robotics and AI for the diagnosis of cerebrovascular pathology, 2) robotics and AI for the treatment of cerebrovascular pathology, 3) robotics and AI for training in neuroendovascular procedures, and 4) robotics and AI for clinical outcome optimization. The 38 articles presented include 23 articles on AI-based diagnosis of cerebrovascular disease, 10 articles on AI-based treatment of cerebrovascular disease, two articles on AI-based training techniques for neuroendovascular procedures, and three articles reporting AI prediction models of clinical outcomes in vascular disorders of the brain. Innovation with robotics and AI focus on diagnostic efficiency, optimizing treatment and interventional procedures, improving physician procedural performance, and predicting clinical outcomes with the use of artificial intelligence and robotics. Experimental studies with robotic systems have demonstrated safety and efficacy in treating cerebrovascular disorders, and novel microcatheterization techniques may permit access to deeper brain regions. Other studies show that pre-procedural simulations increase overall physician performance. Artificial intelligence also shows superiority over existing statistical tools in predicting clinical outcomes. The recent advances and current usage of robotics and AI in the endovascular neurosurgery field suggest that the collaboration between physicians and machines has a bright future for the improvement of patient care. The aim of this work is to equip the medical readership, in particular the neurosurgical specialty, with tools to better understand and apply findings from research on artificial intelligence and robotics in endovascular neurosurgery.
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Lu Q, Sun Z, Zhang J, Zhang J, Zheng J, Qian F. A Novel Remote-Controlled Vascular Interventional Robotic System Based on Hollow Ultrasonic Motor. MICROMACHINES 2022; 13:mi13030410. [PMID: 35334702 PMCID: PMC8954608 DOI: 10.3390/mi13030410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
Cardiovascular diseases (CVDs) are the deadliest diseases worldwide. Master-slave robotic systems have been widely used in vascular interventional surgery with the benefit of high safety, efficient operation, and procedural facilitation. This paper introduces a remote-controlled vascular interventional robot (RVIR) that aims to enable surgeons to perform complex vascular interventions reliably and accurately under a magnetic resonance imaging (MRI) environment. The slave robot includes a guidewire manipulator (GM) and catheter manipulator (CM) that are mainly composed of a hollow driving mechanism and a linear motion platform. The hollow driving mechanism is based on a traveling wave-type hollow ultrasonic motor (HUM) which has high positional precision, fast response, and magnetic interference resistance and realizes the cooperation of the guidewire and catheter by omitting the redundant transmission mechanism and maintaining good coaxiality. The HUM stator, the core part of the RVIR, is optimized by an adaptive genetic algorithm for better quality and greater amplitude of traveling waves, which are beneficial to the drive efficiency and precision. The robot system features great cooperating performance, small hysteresis, and high kinematic accuracy and has been experimentally verified for its capability to precisely manipulate the guidewire and catheter.
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Desai VR, Lee JJ, Sample T, Kleiman NS, Lumsden A, Britz GW. First in Man Pilot Feasibility Study in Extracranial Carotid Robotic-Assisted Endovascular Intervention. Neurosurgery 2021; 88:506-514. [PMID: 33313923 DOI: 10.1093/neuros/nyaa461] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Robotic-assistance in endovascular intervention represents a nascent yet promising innovation. OBJECTIVE To present the first human experience utilizing robotic-assisted angiography in the extracranial carotid circulation. METHODS Between March 2019 and September 2019, patients with extracranial carotid circulation pathology presenting to Houston Methodist Hospital were enrolled. RESULTS A total of 6 patients met inclusion criteria: 5 underwent diagnostic angiography only with robotic-assisted catheter manipulation, while 1 underwent both diagnostic followed by delayed therapeutic intervention. Mean age was 51 +/- 17.5 yr. Mean anesthesia time was 158.7 +/- 37.9 min, mean fluoroscopic time was 22.0 +/- 7.3 min, and mean radiation dose was 815.0 +/- 517.0 mGy. There were no technical complications and no clinical deficits postprocedure. None of the cases required conversion to manual neurovascular intervention (NVI). CONCLUSION Incorporating robotic technology in NVI can enhance procedural technique and diminish occupational hazards. Its application in the coronary and peripheral vascular settings has established safety and efficacy, but in the neurovascular setting, this has yet to be demonstrated. This study presents the first in human feasibility experience of robotic-assisted NVI in the extracranial carotid circulation.
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Affiliation(s)
- Virendra R Desai
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Jonathan J Lee
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Trevis Sample
- Department of Endovascular Radiology, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Alan Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
| | - Gavin W Britz
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas
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Jones B, Riga C, Bicknell C, Hamady M. Robot-Assisted Carotid Artery Stenting: A Safety and Feasibility Study. Cardiovasc Intervent Radiol 2021; 44:795-800. [PMID: 33447924 PMCID: PMC8060210 DOI: 10.1007/s00270-020-02759-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Endovascular robotics is an emerging technology within the developing field of medical robotics. This was a prospective evaluation to assess safety and feasibility of robotic-assisted carotid artery stenting. MATERIALS AND METHODS Consecutive cases of carotid artery stenting cases performed over period of 24 months, from May 2015 to October 2016, using the Magellan Robotic System (Hansen, Mountain View, CA) were included. All cases utilised the robotic system to navigate the arch, obtain a stable position in the common carotid artery, followed by manual manipulation of Embolic Protection Devices and self-expandable stents through the robotic catheter. Patients demographics, clinical indications, anatomical features, technical and clinical success, complication rate and hospital stay were prospectively recorded. RESULTS Thirteen patients, 10 males (78.5%), with an average age of 68.7 years were treated. Mean follow up time was 30 months. Ten patients (91%) were symptomatic at presentation. Anatomical indications for endovascular stent insertion were previous open surgery to the neck ± radiotherapy (87.5%) and hostile anatomy for open surgery (12.5%). Technical success was 100% and the robotic system demonstrates enhanced stability during arch and lesion crossing. There were no neurological complications post-operatively. Average hospital stay was 3 days (range 2-6 days) and a change in serum creatinine of -7.8 μmol/L. There was no documented case of in stent restenosis, new or worsening neurology during follow-up. CONCLUSION These results illustrate safety and feasibility of robotic endovascular revascularisation for carotid disease and demonstrates potential to enhance peri-procedural safety through improved control and stability.
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Affiliation(s)
- Ben Jones
- Department of Interventional Radiology, Imperial Health and Academic NHS Trust, London, W2 1NY, UK
| | - Celia Riga
- Department of Surgery and Cancer, Imperial College, London, W2 1NY, UK
| | - Colin Bicknell
- Department of Surgery and Cancer, Imperial College, London, W2 1NY, UK
- Imperial Vascular Unit, St Mary's and Charing Cross Hospitals, Imperial Healthcare NHS Trust, London, UK
| | - Mohamad Hamady
- Department of Interventional Radiology, Imperial Health and Academic NHS Trust, London, W2 1NY, UK.
- Department of Surgery and Cancer, Imperial College, London, W2 1NY, UK.
- Imperial Vascular Unit, St Mary's and Charing Cross Hospitals, Imperial Healthcare NHS Trust, London, UK.
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Cheung S, Rahman R, Bicknell C, Stoyanov D, Chang PL, Li M, Rolls A, Desender L, Van Herzeele I, Hamady M, Riga C. Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair. Int J Comput Assist Radiol Surg 2020; 15:2071-2078. [PMID: 33070273 DOI: 10.1007/s11548-020-02247-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Robotic endovascular technology may offer advantages over conventional manual catheter techniques. Our aim was to compare the endovascular catheter path-length (PL) for robotic versus manual contralateral gate cannulation during endovascular aneurysm repair (EVAR), using video motion analysis (VMA). METHODS This was a multicentre retrospective cohort study with fluoroscopic video recordings of 24 EVAR cases (14 robotic, 10 manual) performed by experienced operators (> 50 procedures), obtained from four leading European centres. Groups were comparable with no statistically significant differences in aneurysm size (p = 0.47) or vessel tortuosity (p = 0.68). Two trained assessors used VMA to calculate the catheter PL during contralateral gate cannulation for robotic versus manual approaches. RESULTS There was a high degree of inter-observer reliability (Cronbach's α > 0.99) for VMA. Median robotic PL was 35.7 cm [interquartile range, IQR (30.8-51.0)] versus 74.1 cm [IQR (44.3-170.4)] for manual cannulation, p = 0.019. Robotic cases had a median cannulation time of 5.33 min [IQR (4.58-6.49)] versus 1.24 min [IQR (1.13-1.35)] in manual cases (p = 0.0083). Generated efficiency ratios (PL/aorto-iliac centrelines) was 1.6 (1.2-2.1) in robotic cases versus 2.6 (1.7-7.0) in manual, p = 0.031. CONCLUSION Robot-assisted contralateral gate cannulation in EVAR leads to decreased navigation path lengths and increased economy of movement compared with manual catheter techniques. The benefit could be maximised by prioritising robotic catheter shaping over habituated reliance on guidewire manipulation. Robotic technology has the potential to reduce the endovascular footprint during manipulations even for experienced operators with the added advantage of zero radiation exposure.
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Affiliation(s)
- Sheena Cheung
- Division of Surgery and Cancer, Imperial College London, London, UK
| | - Rafid Rahman
- Division of Surgery and Cancer, Imperial College London, London, UK
| | - Colin Bicknell
- Division of Surgery and Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Danail Stoyanov
- Centre for Medical Image Computing, University College London, London, UK
| | - Ping-Lin Chang
- Centre for Medical Image Computing, University College London, London, UK
| | - Mimi Li
- Division of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander Rolls
- Division of Surgery and Cancer, Imperial College London, London, UK
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Mohamad Hamady
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Celia Riga
- Division of Surgery and Cancer, Imperial College London, London, UK. .,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK. .,1003 Queen Elizabeth The Queen Mother Wing (QEQM), St Mary's Hospital, Praed St, Paddington, London, W2 1NY, UK.
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Feddal A, Escalard S, Delvoye F, Fahed R, Desilles JP, Zuber K, Redjem H, Savatovsky JS, Ciccio G, Smajda S, Ben Maacha M, Mazighi M, Piotin M, Blanc R. Fusion Image Guidance for Supra-Aortic Vessel Catheterization in Neurointerventions: A Feasibility Study. AJNR Am J Neuroradiol 2020; 41:1663-1669. [PMID: 32819903 DOI: 10.3174/ajnr.a6707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular navigation through tortuous vessels can be complex. Tools that can optimise this access phase need to be developed. Our aim was to evaluate the feasibility of supra-aortic vessel catheterization guidance by means of live fluoroscopy fusion with MR angiography or CT angiography. MATERIALS AND METHODS Twenty-five patients underwent preinterventional diagnostic MRA, and 8 patients underwent CTA. Fusion guidance was evaluated in 35 sessions of catheterization, targeting a total of 151 supra-aortic vessels. The time for MRA/CTA segmentation and fluoroscopy with MRA/CTA coregistration was recorded. The feasibility of fusion guidance was evaluated by recording the catheterizations executed by interventional neuroradiologists according to a standard technique under fluoroscopy and conventional road-mapping independent of the fusion guidance. Precision of the fusion roadmap was evaluated by measuring (on a semiquantitative 3-point scale) the maximum offset between the position of the guidewires/catheters and the vasculature on the virtual CTA/MRA images. The targeted vessels were divided in 2 groups according to their position from the level of the aortic arch. RESULTS The average time needed for segmentation and image coregistration was 7 ± 2 minutes. The MRA/CTA virtual roadmap overlaid on live fluoroscopy was considered accurate in 84.8% (128/151) of the assessed landmarks, with a higher accuracy for the group of vessels closer to the aortic arch (92.4%; OR, 4.88; 95% CI, 1.83-11.66; P = .003). CONCLUSIONS Fluoroscopy with MRA/CTA fusion guidance for supra-aortic vessel interventions is feasible. Further improvements of the technique to increase accuracy at the cervical level and further studies are needed for assessing the procedural time savings and decreasing the x-ray radiation exposure.
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Affiliation(s)
- A Feddal
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Escalard
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Delvoye
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Fahed
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J P Desilles
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - K Zuber
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - H Redjem
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - J S Savatovsky
- Diagnostic Neuroradiology Unit (J.S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - G Ciccio
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - S Smajda
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Ben Maacha
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Mazighi
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - M Piotin
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - R Blanc
- From the Interventional Neuroradiology Unit (A.F., S.E., F.D., R.F., J.P.D., K.Z., H.R., G.C., S.S., M.B.M., M.M., M.P., R.B.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- Université Paris Denis Diderot (J.P.D., M.M., M.P., R.B.), Sorbonne Paris Cite, Paris, France
- Laboratory of Vascular Translational Science (J.P.D., M.M., M.P., R.B.), U1148 Institut National de la Santé et de la Recherche Médicale, Paris, France
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12
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Legeza P, Britz GW, Loh T, Lumsden A. Current utilization and future directions of robotic-assisted endovascular surgery. Expert Rev Med Devices 2020; 17:919-927. [PMID: 32835546 DOI: 10.1080/17434440.2020.1814742] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Endovascular surgery has become the standard of care to treat most vascular diseases using a minimally invasive approach. The CorPath system further enhances the potential and enables surgeons to perform robotic-assisted endovascular procedures in interventional cardiology, peripheral vascular surgery, and neurovascular surgery. With the introduction of this technique, the operator can perform multiple steps of endovascular interventions outside of the radiation field with high precision movements even from long-geographical distances. AREAS COVERED The first and second-generation CorPath systems are currently the only commercially available robotic devices for endovascular surgery. This review article discusses the clinical experiences and outcomes with the robot, the advanced navigational features, and the results with recent hardware and software modifications, which enables the use of the system for neurovascular interventions, and long-distance interventional procedures. EXPERT OPINION A high procedural success was achieved with the CorPath robotic systems in coronary and peripheral interventions, and the device seems promising in neurovascular procedures. More experience is needed with robotic neurovascular interventions and with complex peripheral arterial cases. In the future, long-distance endovascular surgery can potentially transform the management and treatment of acute myocardial infarction and stroke, with making endovascular care more accessible for patients in remote areas.
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Affiliation(s)
- Peter Legeza
- Department of Cardiovascular Surgery, Houston Methodist Hospital , Houston, Texas, USA.,Department of Vascular Surgery, Semmelweis University , Budapest, Hungary
| | - Gavin W Britz
- Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital , Houston, Texas, USA
| | - Thomas Loh
- Department of Cardiovascular Surgery, Houston Methodist Hospital , Houston, Texas, USA
| | - Alan Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital , Houston, Texas, USA
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13
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Hu X, Chen A, Luo Y, Zhang C, Zhang E. Steerable catheters for minimally invasive surgery: a review and future directions. Comput Assist Surg (Abingdon) 2019; 23:21-41. [PMID: 30497292 DOI: 10.1080/24699322.2018.1526972] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The steerable catheter refers to the catheter that is manipulated by a mechanism which may be driven by operators or by actuators. The steerable catheter for minimally invasive surgery has rapidly become a rich and diverse area of research. Many important achievements in design, application and analysis of the steerable catheter have been made in the past decade. This paper aims to provide an overview of the state of arts of steerable catheters. Steerable catheters are classified into four main groups based on the actuation principle: (1) tendon driven catheters, (2) magnetic navigation catheters, (3) soft material driven catheters (shape memory effect catheters, steerable needles, concentric tubes, conducting polymer driven catheters and hydraulic pressure driven catheters), and (4) hybrid actuation catheters. The advantages and limitations of each of them are commented and discussed in this paper. The future directions of research are summarized.
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Affiliation(s)
- Xiaohua Hu
- a School of Mechatronic Engineering and Automation , Shanghai University , Shanghai , P.R. China.,b Division of Biomedical Engineering , University of Saskatchewan , Saskatoon , SK , Canada
| | - Ang Chen
- b Division of Biomedical Engineering , University of Saskatchewan , Saskatoon , SK , Canada
| | - Yigang Luo
- b Division of Biomedical Engineering , University of Saskatchewan , Saskatoon , SK , Canada.,c Department of Surgery , University of Saskatchewan , Saskatoon , SK , Canada
| | - Chris Zhang
- a School of Mechatronic Engineering and Automation , Shanghai University , Shanghai , P.R. China.,b Division of Biomedical Engineering , University of Saskatchewan , Saskatoon , SK , Canada
| | - Edwin Zhang
- d Department of Medical Imaging , University of Toronto , Toronto , Canada
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14
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Zhou XH, Bian GB, Xie XL, Hou ZG, Qu X, Guan S. Analysis of Interventionalists' Natural Behaviors for Recognizing Motion Patterns of Endovascular Tools During Percutaneous Coronary Interventions. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:330-342. [PMID: 30640627 DOI: 10.1109/tbcas.2019.2892411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Many robotic platforms can indeed reduce radiation exposure to clinicians during percutaneous coronary intervention (PCI), however, interventionalists' natural manipulations are rarely involved in robot-assisted PCI. This requires more attention to analyze interventionalists' natural behaviors during conventional PCI. In this study, four types of natural behavior (i.e., muscle activity, hand motion, proximal force, and finger motion) were synchronously acquired from ten subjects while performing six typical types of guidewire manipulation. These behaviors are evaluated by a hidden Markov model (HMM) based analysis framework for relevant behavior selection. Relevant behaviors are further used as the input of two HMM-based classification frameworks to recognize guidewire motion patterns. Experimental results show that under the basic classification framework (BCF), 91.01% and 93.32% recognition accuracies can be achieved by using all behaviors and relevant behaviors, respectively. Furthermore, the hierarchical classification framework can significantly enhance the recognition ability of relevant behaviors with an accuracy of 96.39%. These promising results demonstrate great potential of proposed methods for promoting the future design of human-robot interfaces in robot-assisted PCI.
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15
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Abstract
The current state and the future direction.
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Affiliation(s)
| | - Celia Riga
- Imperial Vascular Unit, Imperial Healthcare NHS Trust , London
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16
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Study on real-time force feedback for a master–slave interventional surgical robotic system. Biomed Microdevices 2018; 20:37. [DOI: 10.1007/s10544-018-0278-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Schwein A, Kramer B, Chinnadurai P, Virmani N, Walker S, O'Malley M, Lumsden AB, Bismuth J. Electromagnetic tracking of flexible robotic catheters enables “assisted navigation” and brings automation to endovascular navigation in an in vitro study. J Vasc Surg 2018; 67:1274-1281. [DOI: 10.1016/j.jvs.2017.01.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/29/2017] [Indexed: 11/28/2022]
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18
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A cooperation of catheters and guidewires-based novel remote-controlled vascular interventional robot. Biomed Microdevices 2018; 20:20. [PMID: 29460178 DOI: 10.1007/s10544-018-0261-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Remote-controlled vascular interventional robots (RVIRs) are being developed to increase the overall accuracy of surgical operations and reduce the occupational risks of intervening physicians, such as radiation exposure and chronic neck/back pain. Several RVIRs have been used to operate catheters or guidewires accurately. However, a lack of cooperation between the catheters and guidewires results in the surgeon being unable to complete complex surgery by propelling the catheter/guidewire to the target position. Furthermore, it is a significant challenge to operate the catheter/guidewire accurately and detect their proximal force without damaging their surfaces. In this study, we introduce a novel method that allows catheters and guidewires to be operated simultaneously in complex surgery. Our method accurately captures force measurements and enables precisely controlled catheter and guidewire operation. A prototype is validated through various experiments. The results demonstrate the feasibility of the proposed RVIR to operate a catheter and guidewire accurately, detect the resistance forces, and complete complex surgical operations in a cooperative manner.
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19
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Couture T, Szewczyk J. Design and Experimental Validation of an Active Catheter for Endovascular Navigation. J Med Device 2017. [DOI: 10.1115/1.4038334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Endovascular techniques have many advantages but rely strongly on operator skills and experience. Robotically steerable catheters have been developed but few are clinically available. We describe here the development of an active and efficient catheter based on shape memory alloys (SMA) actuators. We first established the specifications of our device considering anatomical constraints. We then present a new method for building active SMA-based catheters. The proposed method relies on the use of a core body made of three parallel metallic beams and integrates wire-shaped SMA actuators. The complete device is encapsulated into a standard 6F catheter for safety purposes. A trial-and-error campaign comparing 70 different prototypes was conducted to determine the best dimensions of the core structure and of the SMA actuators with respect to the imposed specifications. The final prototype was tested on a silicon-based arterial model and on a 23 kg pig. During these experiments, we were able to cannulate the supra-aortic trunks and the renal arteries with different angulations and without any complication. A second major contribution of this paper is the derivation of a reliable mathematical model for predicting the bending angle of our active catheters. We first use this model to state some general qualitative rules useful for an iterative dimensional optimization. We then perform a quantitative comparison between the actual and the predicted bending angles for a set of 13 different prototypes. The relative error is less than 20% for bending angles between 100 deg and 150 deg, which is the interval of interest for our applications.
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Affiliation(s)
- Thibault Couture
- Service de Chirurgie vasculaire, Hôpital Pitié-Salpêtrière, 52 Boulevard Vincent-Auriol, Paris 75013, France e-mail:
| | - Jérôme Szewczyk
- Institut des Systèmes Intelligents et de Robotique, Université Pierre et Marie Curie, Boîte courrier 173, 4 place Jussieu, Paris 75252, France, e-mail:
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Pourdjabbar A, Ang L, Behnamfar O, Patel MP, Reeves RR, Campbell PT, Madder RD, Mahmud E. Robotics in percutaneous cardiovascular interventions. Expert Rev Cardiovasc Ther 2017; 15:825-833. [PMID: 28914558 DOI: 10.1080/14779072.2017.1377071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.
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Affiliation(s)
- Ali Pourdjabbar
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Lawrence Ang
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Omid Behnamfar
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Mitul P Patel
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Ryan R Reeves
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | | | - Ryan D Madder
- c Frederik Meijer Heart & Vascular Institute, Spectrum Health , Grand Rapids , MI , USA
| | - Ehtisham Mahmud
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
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21
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Mahmud E, Pourdjabbar A, Ang L, Behnamfar O, Patel MP, Reeves RR. Robotic technology in interventional cardiology: Current status and future perspectives. Catheter Cardiovasc Interv 2017; 90:956-962. [DOI: 10.1002/ccd.27209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/24/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ehtisham Mahmud
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Ali Pourdjabbar
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Lawrence Ang
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Omid Behnamfar
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Mitul P. Patel
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Ryan R. Reeves
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
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Abstract
Several remote catheter navigation systems have been developed and are now commercially available. However, these systems typically require specialized catheters or equipment, as well as time-consuming operations for the system set-up. In this paper, we present CathROB, a highly compact and versatile robotic system for remote navigation of standard tip-steerable electrophysiology (EP) catheters. Key features of CathROB include an extremely compact design that minimizes encumbrance and time for system set-up in a standard cath lab, a force-sensing mechanism, an intuitive command interface, and functions for automatic catheter navigation and repositioning. We report in vitro and in vivo animal evaluation of CathROB. In vitro results showed good accuracy in remote catheter navigation and automatic repositioning (1.5 ± 0.6 mm for the left-side targets, 1.7 ± 0.4 mm for the right-side targets). Adequate tissue contact was achieved with remote navigation in vivo. There were no adverse events, including absence of cardiac perforation or cardiac damage, indicative of the safety profile of CathROB. Although further preclinical and clinical studies are required, the presented CathROB system seems to be a promising solution for an affordable and easy-to-use remote catheter navigation.
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23
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Robotic Arch Catheter Placement Reduces Cerebral Embolization During Thoracic Endovascular Aortic Repair (TEVAR). Eur J Vasc Endovasc Surg 2017; 53:362-369. [DOI: 10.1016/j.ejvs.2016.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022]
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24
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Aziz F. Invited commentary. J Vasc Surg 2017; 65:537. [DOI: 10.1016/j.jvs.2016.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022]
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25
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Rafii-Tari H, Riga CV, Payne CJ, Hamady MS, Cheshire NJ, Bicknell CD, Yang GZ. Reducing contact forces in the arch and supra-aortic vessels using the Magellan robot. J Vasc Surg 2016; 64:1422-1432. [DOI: 10.1016/j.jvs.2015.06.215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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26
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Mazomenos EB, Chang PL, Rippel RA, Rolls A, Hawkes DJ, Bicknell CD, Desjardins A, Riga CV, Stoyanov D. Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation. Int J Comput Assist Radiol Surg 2016; 11:1121-31. [PMID: 27072837 PMCID: PMC4893379 DOI: 10.1007/s11548-016-1391-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/16/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE Transcatheter aortic valve implantation (TAVI) demands precise and efficient handling of surgical instruments within the confines of the aortic anatomy. Operational performance and dexterous skills are critical for patient safety, and objective methods are assessed with a number of manipulation features, derived from the kinematic analysis of the catheter/guidewire in fluoroscopy video sequences. METHODS A silicon phantom model of a type I aortic arch was used for this study. Twelve endovascular surgeons, divided into two experience groups, experts ([Formula: see text]) and novices ([Formula: see text]), performed cannulation of the aorta, representative of valve placement in TAVI. Each participant completed two TAVI experiments, one with conventional catheters and one with the Magellan robotic platform. Video sequences of the fluoroscopic monitor were recorded for procedural processing. A semi-automated tracking software provided the 2D coordinates of the catheter/guidewire tip. In addition, the aorta phantom was segmented in the videos and the shape of the entire catheter was manually annotated in a subset of the available video frames using crowdsourcing. The TAVI procedure was divided into two stages, and various metrics, representative of the catheter's overall navigation as well as its relative movement to the vessel wall, were developed. RESULTS Experts consistently exhibited lower values of procedure time and dimensionless jerk, and higher average speed and acceleration than novices. Robotic navigation resulted in increased average distance to the vessel wall in both groups, a surrogate measure of safety and reduced risk of embolisation. Discrimination of experience level and types of equipment was achieved with the generated motion features and established clustering algorithms. CONCLUSIONS Evaluation of surgical skills is possible through the analysis of the catheter/guidewire motion pattern. The use of robotic endovascular platforms seems to enable more precise and controlled catheter navigation.
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Affiliation(s)
- Evangelos B Mazomenos
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK.
| | - Ping-Lin Chang
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK
| | - Radoslaw A Rippel
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Alexander Rolls
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - David J Hawkes
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK
- Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK
| | - Colin D Bicknell
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Adrien Desjardins
- Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK
| | - Celia V Riga
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Danail Stoyanov
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK
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Duran C, Estrada S, O'Malley M, Sheahan MG, Shames ML, Lee JT, Bismuth J. The model for Fundamentals of Endovascular Surgery (FEVS) successfully defines the competent endovascular surgeon. J Vasc Surg 2016; 62:1660-6.e3. [PMID: 26598123 DOI: 10.1016/j.jvs.2015.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 09/23/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fundamental skills testing is now required for certification in general surgery. No model for assessing fundamental endovascular skills exists. Our objective was to develop a model that tests the fundamental endovascular skills and differentiates competent from noncompetent performance. METHODS The Fundamentals of Endovascular Surgery model was developed in silicon and virtual-reality versions. Twenty individuals (with a range of experience) performed four tasks on each model in three separate sessions. Tasks on the silicon model were performed under fluoroscopic guidance, and electromagnetic tracking captured motion metrics for catheter tip position. Image processing captured tool tip position and motion on the virtual model. Performance was evaluated using a global rating scale, blinded video assessment of error metrics, and catheter tip movement and position. Motion analysis was based on derivations of speed and position that define proficiency of movement (spectral arc length, duration of submovement, and number of submovements). RESULTS Performance was significantly different between competent and noncompetent interventionalists for the three performance measures of motion metrics, error metrics, and global rating scale. The mean error metric score was 6.83 for noncompetent individuals and 2.51 for the competent group (P < .0001). Median global rating scores were 2.25 for the noncompetent group and 4.75 for the competent users (P < .0001). CONCLUSIONS The Fundamentals of Endovascular Surgery model successfully differentiates competent and noncompetent performance of fundamental endovascular skills based on a series of objective performance measures. This model could serve as a platform for skills testing for all trainees.
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Affiliation(s)
- Cassidy Duran
- Methodist DeBakey Heart & Vascular Center, Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex.
| | - Sean Estrada
- Department of Mechanical Engineering, Mechatronics and Haptics Interfaces Laboratory, Rice University, Houston, Tex
| | - Marcia O'Malley
- Department of Mechanical Engineering, Mechatronics and Haptics Interfaces Laboratory, Rice University, Houston, Tex
| | - Malachi G Sheahan
- Department of Vascular Surgery, Louisiana State University School of Medicine, New Orleans, La
| | - Murray L Shames
- Department of Surgery, University of South Florida, Tampa, Fla
| | - Jason T Lee
- Department of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Jean Bismuth
- Methodist DeBakey Heart & Vascular Center, Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
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28
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Lee SL, Kwok KW, Wang L, Riga C, Bicknell C, Cheshire N, Yang GZ. Motion-adapted catheter navigation with real-time instantiation and improved visualisation. J Robot Surg 2016; 7:251-60. [PMID: 24744817 DOI: 10.1007/s11701-013-0423-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The improvements to catheter manipulation by the use of robot-assisted catheter navigation for endovascular procedures include increased precision, stability of motion and operator comfort. However, navigation through the vasculature under fluoroscopic guidance is still challenging, mostly due to physiological motion and when tortuous vessels are involved. In this paper, we propose a motion-adaptive catheter navigation scheme based on shape modelling to compensate for these dynamic effects, permitting predictive and dynamic navigations. This allows for timed manipulations synchronised with the vascular motion. The technical contribution of the paper includes the following two aspects. Firstly, a dynamic shape modelling and real-time instantiation scheme based on sparse data obtained intra-operatively is proposed for improved visualisation of the 3D vasculature during endovascular intervention. Secondly, a reconstructed frontal view from the catheter tip using the derived dynamic model is used as an interventional aid to user guidance. To demonstrate the practical value of the proposed framework, a simulated aortic branch cannulation procedure is used with detailed user validation to demonstrate the improvement in navigation quality and efficiency.
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Affiliation(s)
- Su-Lin Lee
- Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK.
| | - Ka-Wai Kwok
- Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
| | - Lichao Wang
- Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
| | - Celia Riga
- Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
| | - Colin Bicknell
- Academic Division of Surgery, Imperial College London, London, UK
| | | | - Guang-Zhong Yang
- Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
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29
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Schwein A, Kramer B, Chinnadurai P, Walker S, O'Malley M, Lumsden A, Bismuth J. Flexible robotics with electromagnetic tracking improves safety and efficiency during in vitro endovascular navigation. J Vasc Surg 2016; 65:530-537. [PMID: 26994950 DOI: 10.1016/j.jvs.2016.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE One limitation of the use of robotic catheters is the lack of real-time three-dimensional (3D) localization and position updating: they are still navigated based on two-dimensional (2D) X-ray fluoroscopic projection images. Our goal was to evaluate whether incorporating an electromagnetic (EM) sensor on a robotic catheter tip could improve endovascular navigation. METHODS Six users were tasked to navigate using a robotic catheter with incorporated EM sensors in an aortic aneurysm phantom. All users cannulated two anatomic targets (left renal artery and posterior "gate") using four visualization modes: (1) standard fluoroscopy mode (control), (2) 2D fluoroscopy mode showing real-time virtual catheter orientation from EM tracking, (3) 3D model of the phantom with anteroposterior and endoluminal view, and (4) 3D model with anteroposterior and lateral view. Standard X-ray fluoroscopy was always available. Cannulation and fluoroscopy times were noted for every mode. 3D positions of the EM tip sensor were recorded at 4 Hz to establish kinematic metrics. RESULTS The EM sensor-incorporated catheter navigated as expected according to all users. The success rate for cannulation was 100%. For the posterior gate target, mean cannulation times in minutes:seconds were 8:12, 4:19, 4:29, and 3:09, respectively, for modes 1, 2, 3 and 4 (P = .013), and mean fluoroscopy times were 274, 20, 29, and 2 seconds, respectively (P = .001). 3D path lengths, spectral arc length, root mean dimensionless jerk, and number of submovements were significantly improved when EM tracking was used (P < .05), showing higher quality of catheter movement with EM navigation. CONCLUSIONS The EM tracked robotic catheter allowed better real-time 3D orientation, facilitating navigation, with a reduction in cannulation and fluoroscopy times and improvement of motion consistency and efficiency.
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Affiliation(s)
- Adeline Schwein
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex.
| | - Ben Kramer
- Department of Mechanical Engineering, Rice University, Houston, Tex
| | | | | | - Marcia O'Malley
- Department of Mechanical Engineering, Rice University, Houston, Tex
| | - Alan Lumsden
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Jean Bismuth
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
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30
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Chinnadurai P, Duran C, Al-Jabbari O, Abu Saleh WK, Lumsden A, Bismuth J. Value of C-Arm Cone Beam Computed Tomography Image Fusion in Maximizing the Versatility of Endovascular Robotics. Ann Vasc Surg 2016; 30:138-48. [DOI: 10.1016/j.avsg.2015.06.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/09/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
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Kato T, Okumura I, Kose H, Takagi K, Hata N. Tendon-driven continuum robot for neuroendoscopy: validation of extended kinematic mapping for hysteresis operation. Int J Comput Assist Radiol Surg 2015; 11:589-602. [PMID: 26476639 DOI: 10.1007/s11548-015-1310-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/28/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The hysteresis operation is an outstanding issue in tendon-driven actuation--which is used in robot-assisted surgery--as it is incompatible with kinematic mapping for control and trajectory planning. Here, a new tendon-driven continuum robot, designed to fit existing neuroendoscopes, is presented with kinematic mapping for hysteresis operation. METHODS With attention to tension in tendons as a salient factor of the hysteresis operation, extended forward kinematic mapping (FKM) has been developed. In the experiment, the significance of every component in the robot for the hysteresis operation has been investigated. Moreover, the prediction accuracy of postures by the extended FKM has been determined experimentally and compared with piecewise constant curvature assumption. RESULTS The tendons were the most predominant factor affecting the hysteresis operation of the robot. The extended FKM including friction in tendons predicted the postures in the hysteresis operation with improved accuracy (2.89 and 3.87 mm for the single and the antagonistic-tendons layouts, respectively). The measured accuracy was within the target value of 5 mm for planning of neuroendoscopic resection of intraventricle tumors. CONCLUSION The friction in tendons was the most predominant factor for the hysteresis operation in the robot. The extended FKM including this factor can improve prediction accuracy of the postures in the hysteresis operation. The trajectory of the new robot can be planned within target value for the neuroendoscopic procedure by using the extended FKM.
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Affiliation(s)
- Takahisa Kato
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Healthcare Optics Research Laboratory, Canon U.S.A., Inc., Cambridge, MA, USA
| | | | | | | | - Nobuhiko Hata
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Cochennec F, Kobeiter H, Gohel M, Marzelle J, Desgranges P, Allaire E, Becquemin JP. Feasibility and Safety of Renal and Visceral Target Vessel Cannulation Using Robotically Steerable Catheters During Complex Endovascular Aortic Procedures. J Endovasc Ther 2015; 22:187-93. [DOI: 10.1177/1526602815573228] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the safety and success of target vessel cannulation in the visceral aortic segment using the Magellan robotic catheter system (RCS) during complex endovascular aortic procedures. Methods: Robotic navigation was attempted for access to 37 target vessels in 15 patients (14 men; mean age 75±10 years) during 16 fenestrated and/or branched stent-grafting procedures and 1 endovascular repair requiring the chimney technique. For each target vessel, robotic navigation was attempted for a maximum of 15 minutes; if cannulation was unsuccessful in that time, manual catheters were employed. Safety was evaluated by recording intraoperative adverse events, intraoperative complications related to robotic navigation, and postoperative complications. Technical success of robotic cannulation, wire cannulation times, and times for inserting the leader over the wire in the target vessels were recorded to assess RCS performance. Results: Successful robotic cannulation was achieved for 30 (81%) of the 37 target vessels, with a median wire cannulation time of 263 seconds (range 40–780) and a median 15 seconds (range 5–450) for inserting the leader over the wire. No intraoperative complications related to robotic navigation were observed. Seven of 27 arteries accessed via 7 fenestrations could not be cannulated within 15 minute s; all were cannulated successfully using conventional catheters (mean cannulation time 31±7 minutes). All 10 target vessels accessed via branches and chimney stents were successfully cannulated with the RCS. Conclusion: Cannulation of target vessels with the RCS during complex endovascular aortic procedures is feasible and safe. The robotic system was particularly effective for branched and chimney stents.
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Affiliation(s)
| | | | - Manj Gohel
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Duran C, Estrada S, O'Malley M, Lumsden AB, Bismuth J. Kinematics effectively delineate accomplished users of endovascular robotics with a physical training model. J Vasc Surg 2015; 61:535-41. [DOI: 10.1016/j.jvs.2014.10.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
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Robotic catheterization: the importance of evaluation by interventional radiologists. J Vasc Interv Radiol 2014; 25:1848-9. [PMID: 25457138 DOI: 10.1016/j.jvir.2014.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 11/20/2022] Open
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Robot-Assisted Uterine Artery Embolization: A First-in-Woman Safety Evaluation of the Magellan System. J Vasc Interv Radiol 2014; 25:1841-8. [DOI: 10.1016/j.jvir.2014.05.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 01/25/2023] Open
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Endovascular treatment of thoracic aortic aneurysms with a short proximal landing zone using scalloped endografts. J Vasc Surg 2014; 60:1499-506. [DOI: 10.1016/j.jvs.2014.08.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/07/2014] [Indexed: 11/18/2022]
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de Ruiter QMB, Moll FL, van Herwaarden JA. Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair. J Vasc Surg 2014; 61:256-64. [PMID: 25441011 DOI: 10.1016/j.jvs.2014.08.069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study reviewed the current developments in manual tracking and robotic navigation technologies for application in endovascular aortic aneurysm repair (EVAR). METHODS EMBASE and MEDLINE databases were searched for studies reporting manual tracking or robotic navigation systems that are able to manipulate endovascular surgical tools during abdominal or thoracic aortic aneurysm repair. Reports were grouped by the navigation systems and categorized into phantom, animal, and clinical studies. First, the general characteristics of each system were compared. Second, target registration error and deployment error were used to compare the accuracy of the tracking systems. Third, all systems were reviewed for fluoroscopy time (FT), radiation dose, and contrast volumes, if reported, in rigid and nonrigid studies. Fourth, vascular cannulation performance of the systems was compared, studying cannulation time, Imperial College Complex Cannulation Scoring Tool score, and the number of wall hits and catheter movements within rigid studies. RESULTS Of 721 articles and references found, 18 studies of four different navigation systems were included: the Aurora (Northern Digital, Waterloo, Ontario, Canada) tracking system, the StealthStation (Medtronic Inc, Minneapolis, Minn) tracking system, an ultrasound localization tracking system, and the Sensei (Hansen Medical, Mountain View, Calif) steerable remote-controlled robotic navigation system. The mean tracking accuracy averaged 1 mm for the three manual tracking systems measured in a rigid environment. An increase of target registration error reaching >3 mm was reported when measured in a nonrigid experimental environment or due to external distortion factors. Except within small-animal studies or case studies, no evidence was found on reduction of clinical outcome parameters, such as FT, radiation dose, and contrast volumes, within clinical EVAR. A comparison of vascular cannulation performance in rigid studies revealed that the Sensei robotic system might have an advantage during advanced cannulation compared with standard cannulation within complex cannulations tasks. CONCLUSIONS This review summarizes the current studies on manual tracking and robotic navigation systems for application in EVAR. The main focus of these systems is improving aortic vessel cannulation, required in complex EVAR, in which the robotic system with the improved steerability is favored over manual tracking systems or conventional cannulation. All reviewed tracking systems still require X-ray for anatomic imaging, stent graft deployment, and device registration. Although the current reviewed endovascular navigation systems have shown their potential in phantom and animal studies, clinical trials are too limited to conclude that these systems can improve EVAR outcomes or that they can systematically reduce FTs, radiation doses, and contrast volumes during (complex) EVAR.
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Affiliation(s)
- Quirina M B de Ruiter
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands.
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
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Yoshimitsu K, Kato T, Song SE, Hata N. A novel four-wire-driven robotic catheter for radio-frequency ablation treatment. Int J Comput Assist Radiol Surg 2014; 9:867-74. [PMID: 24510205 DOI: 10.1007/s11548-014-0982-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Robotic catheters have been proposed to increase the efficacy and safety of the radio-frequency ablation treatment. The robotized motion of current robotic catheters mimics the motion of manual ones-namely, deflection in one direction and rotation around the catheter. With the expectation that the higher dexterity may achieve further efficacy and safety of the robotically driven treatment, we prototyped a four-wire-driven robotic catheter with the ability to deflect in two- degree-of-freedom motions in addition to rotation. METHODS A novel quad-directional structure with two wires was designed and developed to attain yaw and pitch motion in the robotic catheter. We performed a mechanical evaluation of the bendability and maneuverability of the robotic catheter and compared it with current manual catheters. RESULTS We found that the four-wire-driven robotic catheter can achieve a pitching angle of 184.7[Formula: see text] at a pulling distance of wire for 11 mm, while the yawing angle was 170.4[Formula: see text] at 11 mm. The robotic catheter could attain the simultaneous two- degree-of-freedom motions in a simulated cardiac chamber. CONCLUSION The results indicate that the four-wire-driven robotic catheter may offer physicians the opportunity to intuitively control a catheter and smoothly approach the focus position that they aim to ablate.
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Affiliation(s)
- Kitaro Yoshimitsu
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, SPL L1-050 ASB1, Boston, MA, USA,
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A Randomized, Controlled Animal Trial Demonstrating the Feasibility and Safety of the Magellan™ Endovascular Robotic System. Ann Vasc Surg 2014; 28:470-8. [DOI: 10.1016/j.avsg.2013.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/01/2013] [Accepted: 07/20/2013] [Indexed: 11/18/2022]
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Condino S, Calabrò E, Alberti A, Parrini S, Cioni R, Berchiolli R, Gesi M, Ferrari V, Ferrari M. Simultaneous Tracking of Catheters and Guidewires: Comparison to Standard Fluoroscopic Guidance for Arterial Cannulation. Eur J Vasc Endovasc Surg 2014; 47:53-60. [DOI: 10.1016/j.ejvs.2013.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/01/2013] [Indexed: 11/15/2022]
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Rippel RA, Rolls AE, Riga CV, Hamady M, Cheshire NJ, Bicknell CD. The use of robotic endovascular catheters in the facilitation of transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2013; 45:836-41. [DOI: 10.1093/ejcts/ezt524] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The purpose of this review is to compare conventional endovascular procedures and the robotic endovascular approach in aortic aneurysm repair. Despite advantages over open surgery, conventional endovascular surgery has limitations. To develop an alternative, efforts have been focused on robotic endovascular systems. Two of the 3 studies comparing procedure times demonstrated reduced procedure time in the robotic group, by 6 times ( p < 0.05). One study demonstrated that robotic procedures reduced fluoroscopic exposure time by 12 minute ( p < 0.001). Three in-vitro studies showed that the number of movements required in robotic surgery was reduced up to 10 times ( p < 0.05). One of 2 studies measuring robotic performance score showed a better performance score in the robotic endovascular group ( p = 0.007). These results demonstrate that the robotic technique has multiple advantages over the conventional procedure, including improved catheter stability, a shorter learning curve, reduced procedure time, and better performance in cannulating tortuous vessels. However, robotic endovascular technology may be limited by the cost of the system, the size of the catheter, and the setup time required preoperatively. Further comparative studies between conventional and robotic approaches regarding cost-effectiveness, safety, and performance in cases involving complex anatomy and fenestrated stent grafts are essential. Nevertheless, this revolutionary technology is increasingly popular and may be the next milestone in endovascular surgery.
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Affiliation(s)
- Stephanie Au
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Koel Ko
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Josephine Tsang
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Lin JC. The Role of Robotic Surgical System in the Management of Vascular Disease. Ann Vasc Surg 2013; 27:976-83. [DOI: 10.1016/j.avsg.2013.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/09/2012] [Accepted: 02/06/2013] [Indexed: 10/26/2022]
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Cochennec F, Riga C, Hamady M, Cheshire N, Bicknell C. Improved catheter navigation with 3D electromagnetic guidance. J Endovasc Ther 2013; 20:39-47. [PMID: 23391082 DOI: 10.1583/12-3951.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the in vitro performance of an electromagnetic navigation system (ENS) in aortic arch branch cannulation and describe its role for fenestrated endograft deployment. METHODS Reconstructed multidetector computed tomography images of silicone phantoms representing the aortic arch and a thoracoabdominal aortic aneurysm were uploaded onto the StealthStation workstation, which provided 3-dimensional visualization of a guidewire by tracking sensors on its tip. For the evaluation of aortic arch branch cannulation, 9 operators were asked to cannulate the phantom's common carotid and left subclavian arteries using the (1) ENS, (2) a 2-dimensional (2D) screen setting simulating fluoroscopy, and (3) both imaging modalities. Analysis included procedure times, number of wall hits, and the Imperial College Complex Cannulation Scoring Tool (IC3ST) qualitative performance score. To evaluate the ability of the ENS during positioning of a fenestrated stent-graft over the visceral segment, a custom-made 4-vessel fenestrated stent-graft with sensors on the fenestrations was deployed 5 consecutive times using the ENS as the exclusive imaging technique. RESULTS In the aortic arch model, cannulation times were significantly longer in the ENS group. However, compared with the 2D version, using both imaging modalities reduced fluoroscopic times [median 26.5 seconds (IQR 19.7-30.7) vs. 87 seconds (IQR 64-128), p<0.0001] and wall hits [median 8.5 (IQR 16-38) vs. 14 (IQR 11-160, p<0.05), while improving IC3ST performance scores [31/35 (IQR 30-31.2) vs. 25/35 (IQR 24-27), p<0.05]. Following deployment of the endograft with tracked fenestrations, the 4 visceral vessels were cannulated in all cases using only the ENS. CONCLUSION The use of the ENS as a complementary imaging modality might be beneficial in terms of radiation exposure, cannulation performance, and positioning of intravascular devices.
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Riga CV, Bicknell CD, Basra M, Hamady M, Cheshire NJ. In Vitro Fenestration of Aortic Stent-Grafts: Implications of Puncture Methods for in Situ Fenestration Durability. J Endovasc Ther 2013; 20:536-43. [DOI: 10.1583/12-4175.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Riga CV, Bicknell CD, Rolls A, Cheshire NJ, Hamady MS. Robot-assisted Fenestrated Endovascular Aneurysm Repair (FEVAR) Using the Magellan System. J Vasc Interv Radiol 2013; 24:191-6. [DOI: 10.1016/j.jvir.2012.10.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/01/2012] [Accepted: 10/06/2012] [Indexed: 11/30/2022] Open
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Learning-based modeling of endovascular navigation for collaborative robotic catheterization. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2013; 16:369-77. [PMID: 24579162 DOI: 10.1007/978-3-642-40763-5_46] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Despite rapid growth of robot assisted catheterization in recent years, most current platforms are based on master-slave designs with limited operator-robot collaborative control and automation. Under this setup, information concerning subject specific behavior and context-driven manoeuvre is not re-utilized for subsequent intervention. For endovascular catheterization, the robot itself is designed with little consideration of underlying skills and associated motion patterns. This paper proposes a learning-based approach for generating optimum motion trajectories from multiple demonstrations of a catheterization task such that it can be used for automating catheter motion within a collaborative setting. Motion models are generated from experienced manipulation of a catheterization procedure and replicated using a robotic catheter driver to assist inexperienced operators. Catheter tip motions of the automated approach are compared against the manual training sets for validating the proposed framework. The results show significant improvements in the quality of catheterization, which facilitate the design of hands-on collaborative robots that make full use of the natural skills of the operators.
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Rippel RA, Kolvekar S. Coronary artery fistula draining into pulmonary artery and optimal management: a review. HEART ASIA 2013; 5:16-7. [PMID: 27326064 DOI: 10.1136/heartasia-2012-010169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/27/2012] [Accepted: 12/20/2012] [Indexed: 11/04/2022]
Abstract
Coronary artery fistula is a rare congenital malformation of high variability. The disease is illustrated with a description of a case example. The management of patients with coronary artery fistulas remains controversial. Both spontaneous regression and life threatening complications have been described. The fistula can be ligated or embolised; however, there are no long term outcome data regarding management. Intraoperative risk of myocardial infarction is less than 5% and death rate varies between 0% and 6%. Due to a small number of cases being described in the literature and a lack of evidence on optimal management, further research is needed in order to determine the best treatment options.
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Affiliation(s)
- Radoslaw Adam Rippel
- Department of Cardiothoracic Surgery, UCLH The Heart Hospital, London, UK; UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Shyam Kolvekar
- Department of Cardiothoracic Surgery, UCLH The Heart Hospital, London, UK; UCL Division of Surgery and Interventional Science, University College London, London, UK
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