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Hamady M. Performance Evaluation of a Miniature and Disposable Endovascular Robotic Device. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03742-9. [PMID: 38772938 DOI: 10.1007/s00270-024-03742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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2
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Najafi G, Kreiser K, Abdelaziz MEMK, Hamady MS. Current State of Robotics in Interventional Radiology. Cardiovasc Intervent Radiol 2023; 46:549-561. [PMID: 37002481 PMCID: PMC10156773 DOI: 10.1007/s00270-023-03421-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/11/2023] [Indexed: 05/04/2023]
Abstract
As a relatively new specialty with a minimally invasive nature, the field of interventional radiology is rapidly growing. Although the application of robotic systems in this field shows great promise, such as with increased precision, accuracy, and safety, as well as reduced radiation dose and potential for teleoperated procedures, the progression of these technologies has been slow. This is partly due to the complex equipment with complicated setup procedures, the disruption to theatre flow, the high costs, as well as some device limitations, such as lack of haptic feedback. To further assess these robotic technologies, more evidence of their performance and cost-effectiveness is needed before their widespread adoption within the field. In this review, we summarise the current progress of robotic systems that have been investigated for use in vascular and non-vascular interventions.
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Affiliation(s)
- Ghazal Najafi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK.
| | - Kornelia Kreiser
- Department of Neuroradiology, Rehabilitations - und Universitätskliniken Ulm, 89081, Ulm, Germany
| | - Mohamed E M K Abdelaziz
- The Hamlyn Centre, Imperial College London, London, SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Mohamad S Hamady
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
- The Hamlyn Centre, Imperial College London, London, SW7 2AZ, UK
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3
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Alawneh Y, Zhou JJ, Sewani A, Tahmasebi M, Roy TL, Kayssi A, Dueck AD, Wright GA, Tavallaei MA. Experimental Protocol and Phantom Design and Development for Performance Characterization of Conventional Devices for Peripheral Vascular Interventions. Ann Biomed Eng 2023:10.1007/s10439-023-03160-x. [PMID: 36808383 DOI: 10.1007/s10439-023-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
Conventional catheter-based interventions for treating peripheral artery disease suffer high failure and complication rates. The mechanical interactions with the anatomy constrain catheter controllability, while their length and flexibility limit their pushability. Also, the 2D X-ray fluoroscopy guiding these procedures fails to provide sufficient feedback about the device location relative to the anatomy. Our study aims to quantify the performance of conventional non-steerable (NS) and steerable (S) catheters in phantom and ex vivo experiments. In a 10 mm diameter, 30 cm long artery phantom model, with four operators, we evaluated the success rate and crossing time in accessing 1.25 mm target channels, the accessible workspace, and the force delivered through each catheter. For clinical relevance, we evaluated the success rate and crossing time in crossing ex vivo chronic total occlusions. For the S and NS catheters, respectively, users successfully accessed 69 and 31% of the targets, 68 and 45% of the cross-sectional area, and could deliver 14.2 and 10.2 g of mean force. Using a NS catheter, users crossed 0.0 and 9.5% of the fixed and fresh lesions, respectively. Overall, we quantified the limitations of conventional catheters (navigation, reachable workspace, and pushability) for peripheral interventions; this can serve as a basis for comparison with other devices.
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Affiliation(s)
- Yara Alawneh
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - James J Zhou
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Alykhan Sewani
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Mohammadmahdi Tahmasebi
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Trisha L Roy
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Ahmed Kayssi
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Andrew D Dueck
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - M Ali Tavallaei
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada.
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of ECBE, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
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Li Z, Manzionna E, Monizzi G, Mastrangelo A, Mancini ME, Andreini D, Dankelman J, De Momi E. Position-based dynamics simulator of vessel deformations for path planning in robotic endovascular catheterization. Med Eng Phys 2022; 110:103920. [PMID: 36564143 DOI: 10.1016/j.medengphy.2022.103920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/14/2022] [Accepted: 11/03/2022] [Indexed: 11/08/2022]
Abstract
A major challenge during autonomous navigation in endovascular interventions is the complexity of operating in a deformable but constrained workspace with an instrument. Simulation of deformations for it can provide a cost-effective training platform for path planning. Aim of this study is to develop a realistic, auto-adaptive, and visually plausible simulator to predict vessels' global deformation induced by the robotic catheter's contact and cyclic heartbeat motion. Based on a Position-based Dynamics (PBD) approach for vessel modeling, Particle Swarm Optimization (PSO) algorithm is employed for an auto-adaptive calibration of PBD deformation parameters and of the vessels movement due to a heartbeat. In-vitro experiments were conducted and compared with in-silico results. The end-user evaluation results were reported through quantitative performance metrics and a 5-Point Likert Scale questionnaire. Compared with literature, this simulator has an error of 0.23±0.13% for deformation and 0.30±0.85mm for the aortic root displacement. In-vitro experiments show an error of 1.35±1.38mm for deformation prediction. The end-user evaluation results show that novices are more accustomed to using joystick controllers, and cardiologists are more satisfied with the visual authenticity. The real-time and accurate performance of the simulator make this framework suitable for creating a dynamic environment for autonomous navigation of robotic catheters.
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Affiliation(s)
- Zhen Li
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy; Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, CD Delft 2628, Netherlands.
| | - Enrico Manzionna
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | | | | | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, CD Delft 2628, Netherlands
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
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5
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Multilevel Operation Strategy of a Vascular Interventional Robot System for Surgical Safety in Teleoperation. IEEE T ROBOT 2022. [DOI: 10.1109/tro.2022.3140887] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cruddas L, Martin G, Riga C. Robotic endovascular surgery: current and future practice. Semin Vasc Surg 2021; 34:233-240. [PMID: 34911629 DOI: 10.1053/j.semvascsurg.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Minimally invasive techniques have been at the forefront of surgical progress, and the evolution of endovascular robotic technologies has seen a paradigm shift in the focus of future innovation. Endovascular robotic technology may help overcome many of the challenges associated with traditional endovascular techniques by enabling greater control, stability, and precision of target navigation and treatment, while simultaneously reducing operator learning curves and improving safety. Several robotic systems have been developed to perform a broad range of endovascular procedures, but none have been used at scale or widely in routine practice, and the evidence for their safety, effectiveness, and efficiency remains limited. High cost and device complexity, lack of haptic feedback, and limited integration and interoperability with existing equipment and devices are the principal technology, cost, and sustainability barriers to the scalability and widespread adoption in day-to-day practice. In order to fully realize its potential, future robotic innovation must ensure compatibility with a range of off-the-shelf equipment that can be tracked and exchanged quickly during a procedure and come together with developments in navigation, tracking, and imaging. Reducing cost and complexity and supporting sustainability of the technology is key. In parallel, new technologies must be evaluated by clear and transparent standardized outcomes and be accompanied by robust clinical training. Key to the successful future development and dissemination of robotic technology is open collaboration among industry, clinicians, and patients in order to fully understand and address current challenges and enable the technology to realize its full potential.
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Affiliation(s)
- Lucinda Cruddas
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Guy Martin
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, 10(th) Floor QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Celia Riga
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, 10(th) Floor QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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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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van Herwaarden JA, Jansen MM, Vonken EJPA, Bloemert-Tuin T, Bullens RWM, de Borst GJ, Hazenberg CEVB. First in Human Clinical Feasibility Study of Endovascular Navigation with Fiber Optic RealShape (FORS) Technology. Eur J Vasc Endovasc Surg 2020; 61:317-325. [PMID: 33262088 DOI: 10.1016/j.ejvs.2020.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/15/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Endovascular procedures are conventionally conducted using two dimensional fluoroscopy. A new technology platform, Fiber Optic RealShape (FORS), has recently been introduced allowing real time, three dimensional visualisation of endovascular devices using fiberoptic technology. It functions as an add on to conventional fluoroscopy and may facilitate endovascular procedures. This first in human study assessed the feasibility of FORS in clinical practice. METHODS A prospective cohort feasibility study was performed between July and December 2018. Patients undergoing (regular or complex) endovascular aortic repair (EVAR) or endovascular peripheral lesion repair (EVPLR) were recruited. FORS guidance was used exclusively during navigational tasks such as target vessel catheterisation or crossing of stenotic lesions. Three types of FORS enabled devices were available: a flexible guidewire, a Cobra-2 catheter, and a Berenstein catheter. Devices were chosen at the physician's discretion and could comprise any combination of FORS and non-FORS devices. The primary study endpoint was technical success of the navigational tasks using FORS enabled devices. Secondary study endpoints were user experience and fluoroscopy time. RESULTS The study enrolled 22 patients: 14 EVAR and eight EVPLR patients. Owing to a technical issue during start up, the FORS system could not be used in one EVAR. The remaining 21 procedures proceeded without device or technology related complications and involved 66 navigational tasks. In 60 tasks (90.9%), technical success was achieved using at least one FORS enabled device. Users rated FORS based image guidance "better than standard guidance" in 16 of 21 and "equal to standard guidance" in five of 21 procedures. Fluoroscopy time ranged from 0.0 to 52.2 min. Several tasks were completed without or with only minimal X-ray use. CONCLUSION Real time navigation using FORS technology is safe and feasible in abdominal and peripheral endovascular procedures. FORS has the potential to improve intra-operative image guidance. Comparative studies are needed to assess these benefits and potential radiation reduction.
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Affiliation(s)
- Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marloes M Jansen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Trijntje Bloemert-Tuin
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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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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Lareyre F, Adam C, Carrier M, Raffort J. Virtual assistants for vascular surgeons. J Vasc Surg 2020; 72:772-773. [PMID: 32711917 DOI: 10.1016/j.jvs.2019.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, University Hospital of Nice, Nice, France; Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice, France
| | - Cédric Adam
- Laboratory of Applied Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, Paris, France
| | - Marion Carrier
- Laboratory of Applied Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, Paris, France
| | - Juliette Raffort
- Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France
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12
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Hooshiar A, Najarian S, Dargahi J. Haptic Telerobotic Cardiovascular Intervention: A Review of Approaches, Methods, and Future Perspectives. IEEE Rev Biomed Eng 2019; 13:32-50. [PMID: 30946677 DOI: 10.1109/rbme.2019.2907458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac diseases are recognized as the leading cause of mortality, hospitalization, and medical prescription globally. The gold standard for the treatment of coronary artery stenosis is the percutaneous cardiac intervention that is performed under live X-ray imaging. Substantial clinical evidence shows that the surgeon and staff are prone to serious health problems due to X-ray exposure and occupational hazards. Telerobotic vascular intervention systems with a master-slave architecture reduced the X-ray exposure and enhanced the clinical outcomes; however, the loss of haptic feedback during surgery has been the main limitation of such systems. This paper is a review of the state of the art for haptic telerobotic cardiovascular interventions. A survey on the literature published between 2000 and 2019 was performed. Results of the survey were screened based on their relevance to this paper. Also, the leading research disciplines were identified based on the results of the survey. Furthermore, different approaches for sensor-based and model-based haptic telerobotic cardiovascular intervention, haptic rendering and actuation, and the pertinent methods were critically reviewed and compared. In the end, the current limitations of the state of the art, unexplored research areas as well as the future perspective of the research on this technology were laid out.
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13
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Mokin M, Waqas M, Setlur Nagesh SV, Karkhanis NV, Levy EI, Ionita CN, Siddiqui AH. Assessment of distal access catheter performance during neuroendovascular procedures: measuring force in three-dimensional patient specific phantoms. J Neurointerv Surg 2018; 11:619-622. [PMID: 30514736 DOI: 10.1136/neurintsurg-2018-014468] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The amount of force applied on a device is an important measure to evaluate the endovascular and surgical device manipulations. The measure has not been evaluated for neuroenodvascular procedures. PURPOSE We aimed to study the use of force measure as a novel approach to test distal access catheter (DAC) performance during catheterization of cervical and intracranial vessels using patient specific 3-dimentional (3D) phantoms. METHODS Using patient specific 3D phantoms of the cervical and intracranial circulation, we recorded measure of force required to deliver three types of DACs beyond the ophthalmic segment of the internal carotid artery. Six different combinations of DAC-microcatheter-guidewire were tested. We intentionally included what we considered suboptimal combinations of DACs, microcatheters, and guidewires during our experiments to test the feasibility of measuring force under different conditions. A six axis force sensor was secured to the DAC with an adjustable torque used to track axially directed push and pull forces required to navigate the DAC to the target site. RESULTS In a total of 55 experiments, we found a significant difference in the amount of force used between different DACs (mean force for DAC A, 1.887±0.531N; for DAC B, 2.153±1.280 N; and for DAC C, 1.194±0.521 N, P=0.007). There was also a significant difference in force measures among the six different catheter systems (P=0.035). CONCLUSIONS Significant difference in the amount of force used between different DACs and catheter systems were recorded. Use of force measure in neuroendovascular procedures on 3D printed phantoms is feasible.
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Affiliation(s)
- Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Swetadri Vasan Setlur Nagesh
- Canon Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Nitant Vivek Karkhanis
- Canon Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.,Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Ciprian N Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.,Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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14
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Current and Future Perspectives in Robotic Endovascular Surgery. CURRENT SURGERY REPORTS 2018. [DOI: 10.1007/s40137-018-0218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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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Comparison of Two Endovascular Steerable Robotic Catheters for Percutaneous Robot-Assisted Fibroid Embolization. Cardiovasc Intervent Radiol 2017; 41:483-488. [DOI: 10.1007/s00270-017-1790-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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17
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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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18
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Rafii-Tari H, Payne CJ, Bicknell C, Kwok KW, Cheshire NJW, Riga C, Yang GZ. Objective Assessment of Endovascular Navigation Skills with Force Sensing. Ann Biomed Eng 2017; 45:1315-1327. [PMID: 28181002 PMCID: PMC5397443 DOI: 10.1007/s10439-017-1791-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/03/2017] [Indexed: 12/18/2022]
Abstract
Despite the increasing popularity of endovascular intervention in clinical practice, there remains a lack of objective and quantitative metrics for skill evaluation of endovascular techniques. Data relating to the forces exerted during endovascular procedures and the behavioral patterns of endovascular clinicians is currently limited. This research proposes two platforms for measuring tool forces applied by operators and contact forces resulting from catheter-tissue interactions, as a means of providing accurate, objective metrics of operator skill within a realistic simulation environment. Operator manipulation patterns are compared across different experience levels performing various complex catheterization tasks, and different performance metrics relating to tool forces, catheter motion dynamics, and forces exerted on the vasculature are extracted. The results depict significant differences between the two experience groups in their force and motion patterns across different phases of the procedures, with support vector machine (SVM) classification showing cross-validation accuracies as high as 90% between the two skill levels. This is the first robust study, validated across a large pool of endovascular specialists, to present objective measures of endovascular skill based on exerted forces. The study also provides significant insights into the design of optimized metrics for improved training and performance assessment of catheterization tasks.
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Affiliation(s)
- Hedyeh Rafii-Tari
- The Hamlyn Centre for Robotic Surgery, Imperial College London, Level 4, Bessemer Building, South Kensington Campus, London, SW7 2AZ, UK.
| | - Christopher J Payne
- The Hamlyn Centre for Robotic Surgery, Imperial College London, Level 4, Bessemer Building, South Kensington Campus, London, SW7 2AZ, UK
| | - Colin Bicknell
- Academic Division of Surgery, Imperial College London, London, UK
| | - Ka-Wai Kwok
- The Hamlyn Centre for Robotic Surgery, Imperial College London, Level 4, Bessemer Building, South Kensington Campus, London, SW7 2AZ, UK.,Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, People's Republic of China
| | | | - Celia Riga
- Academic Division of Surgery, Imperial College London, London, UK
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, Level 4, Bessemer Building, South Kensington Campus, London, SW7 2AZ, UK
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19
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Dosluoglu HH. Commentary on "Robotic Arch Catheter Placement Reduces Cerebral Embolisation During Thoracic Endovascular Aortic Repair (TEVAR)". Eur J Vasc Endovasc Surg 2017; 53:370. [PMID: 28161278 DOI: 10.1016/j.ejvs.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Affiliation(s)
- H H Dosluoglu
- Department of Surgery, Division of Vascular Surgery, State University of New York at Buffalo, Buffalo, NY, USA.
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20
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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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