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Yuan S, Xu C, Cui B, Zhang T, Liang B, Yuan W, Ren H. Motor-free telerobotic endomicroscopy for steerable and programmable imaging in complex curved and localized areas. Nat Commun 2024; 15:7680. [PMID: 39227604 PMCID: PMC11372151 DOI: 10.1038/s41467-024-51633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/12/2024] [Indexed: 09/05/2024] Open
Abstract
Intraluminal epithelial abnormalities, potential precursors to significant conditions like cancer, necessitate early detection for improved prognosis. We present a motor-free telerobotic optical coherence tomography (OCT) endoscope that offers high-resolution intraluminal imaging and overcomes the limitations of traditional systems in navigating curved lumens. This system incorporates a compact magnetic rotor with a rotatable diametrically magnetized cylinder permanent magnet (RDPM) and a reflector, effectively mitigating thermal and electrical risks by utilizing an external magnetic field to maintain temperature increases below 0.5 °C and generated voltage under 0.02 mV. Additionally, a learning-based method corrects imaging distortions resulting from nonuniform rotational speeds. Demonstrating superior maneuverability, the device achieves steerable angles up to 110° and operates effectively in vivo, providing distortion-free 3D programmable imaging in mouse colons. This advancement represents a significant step towards guidewire-independent endomicroscopy, enhancing both safety and potential patient outcomes.
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Affiliation(s)
- Sishen Yuan
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chao Xu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Beilei Cui
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tinghua Zhang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Baijia Liang
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wu Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Hongliang Ren
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Schmid BP, Wolosker N, Cunha MJS, Valle LGM, Galastri FL, Affonso BB, Nasser F. Robotic-Assisted Endovascular Treatment for Transplant Renal Artery Stenosis: A Feasibility Study. Cardiovasc Intervent Radiol 2024; 47:1127-1133. [PMID: 38890185 DOI: 10.1007/s00270-024-03780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE To describe a single-center experience with robotic-assisted endovascular treatment for transplant renal artery stenosis. MATERIALS AND METHODS This is a single-center, retrospective, feasibility study of 4 consecutive cases of robotic-assisted endovascular surgery for transplant renal artery stenosis from October 2021 to August 2022. RESULTS All lesions were identified, and stenting was performed with no complications. Conversion to manual control was not necessary. The mean fluoroscopy time was 25.25 min (range 12-60.9). A control Doppler ultrasound was routinely performed, demonstrating no residual lesions in all cases. There was no reintervention during the follow-up period. The operator learning curve was felt to be acceptable. CONCLUSION Robotic-assisted endovascular treatment is a feasible technique for transplant renal artery stenosis.
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Affiliation(s)
- Bruno Pagnin Schmid
- Department of Interventional Radiology, Hospital Israelita Albert Einstein Avenue, Albert Einstein Avenue, 627, Sao Paulo, SP, 05652-900, Brazil.
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Marcela Juliano Silva Cunha
- Department of Interventional Radiology, Hospital Israelita Albert Einstein Avenue, Albert Einstein Avenue, 627, Sao Paulo, SP, 05652-900, Brazil
| | - Leonardo Guedes Moreira Valle
- Department of Interventional Radiology, Hospital Israelita Albert Einstein Avenue, Albert Einstein Avenue, 627, Sao Paulo, SP, 05652-900, Brazil
| | - Francisco Leonardo Galastri
- Department of Interventional Radiology, Hospital Israelita Albert Einstein Avenue, Albert Einstein Avenue, 627, Sao Paulo, SP, 05652-900, Brazil
| | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein Avenue, Albert Einstein Avenue, 627, Sao Paulo, SP, 05652-900, Brazil
| | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein Avenue, Albert Einstein Avenue, 627, Sao Paulo, SP, 05652-900, Brazil
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Vidal V, Bargellini I, Bent C, Kee S, Little M, O'Sullivan G. Performance Evaluation of a Miniature and Disposable Endovascular Robotic Device. Cardiovasc Intervent Radiol 2024; 47:503-507. [PMID: 38512351 DOI: 10.1007/s00270-024-03686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The LIBERTY® Robotic System is a miniature, single-use device designed to facilitate remote-controlled navigation to intravascular targets. We aim to evaluate the robot's performance to manipulate a range of microguidewires and microcatheters during percutaneous endovascular procedures. MATERIALS AND METHODS Six interventional radiologists performed selective robotic-assisted catheterization of eight pre-determined vascular targets in a pig model. The navigation time from the guiding catheter tip to the target vessel was recorded. Each physician with a clinical experience of 20 years completed a questionnaire to evaluate the ease of use, accuracy, and safety of the robotic operation. RESULTS Most of the physicians reached the vascular targets in less than one minute. There was no angiographic evidence of vascular injury such as artery laceration or contusion. All physicians reported consensus about the high performance of the robot. CONCLUSION The miniature disposable robot is effective at reaching a range of vessels in a porcine model. Physicians found the device intuitive and easy to operate remotely.
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Affiliation(s)
- Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France.
- Aix Marseille University, LIIE, Marseille, France.
- Aix Marseille University, CERIMED, Marseille, France.
| | - Irene Bargellini
- Department of Radiology, Candiolo Cancer Institute, Turin, Italy
| | - Clare Bent
- Department of Interventional Radiology, University Hospitals Dorset, Bournemouth, UK
| | - Stephen Kee
- Department of Radiology, Galway University Hospital, Newcastle Road, Galway, Ireland
| | - Mark Little
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Gerry O'Sullivan
- Department of Radiology, Galway University Hospital, Newcastle Road, Galway, Ireland
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Tasoudis PT, Caranasos TG, Doulamis IP. Robotic applications for intracardiac and endovascular procedures. Trends Cardiovasc Med 2024; 34:110-117. [PMID: 36273775 DOI: 10.1016/j.tcm.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/01/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
The large incisions and long recovery periods that accompany traditional cardiac surgery procedures along with the constant patient demand for minimally invasive procedures have motivated cardiac surgeons to implement the robotic technologies in their armamentarium. The robotic systems have been utilized successfully in various cardiac procedures including atrial septal defect repair, left atrial myxoma resection, MAZE procedure and left ventricular lead placement, yet coronary artery bypass and mitral valve repair still comprise the vast majority of them. This review analyzes the development of the robot-assisted cardiac surgery in recent years, its outcomes, advantages, disadvantages, its patient selection criteria as well as its economic feasibility. Robotic endovascular surgery, albeit its limited applications, is presently considered an attractive alternative to conventional endovascular approaches. The increased flexibility and precision along with the wider range of accessible anatomy provided by the endovascular robotic systems, have increased the pool of patients that can be offered minimally invasive treatment options and have helped to overcome many limitations of the traditional endovascular procedures. With this review we aimed to summarize the applications of the commercially available endovascular robotic devices, as well as the limitations and the future perspectives in the field of endovascular robotic surgery.
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Affiliation(s)
- Panagiotis T Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, NC, United States
| | - Thomas G Caranasos
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, NC, United States
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Rogatinsky J, Recco D, Feichtmeier J, Kang Y, Kneier N, Hammer P, O’Leary E, Mah D, Hoganson D, Vasilyev NV, Ranzani T. A multifunctional soft robot for cardiac interventions. SCIENCE ADVANCES 2023; 9:eadi5559. [PMID: 37878705 PMCID: PMC10599628 DOI: 10.1126/sciadv.adi5559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
In minimally invasive endovascular procedures, surgeons rely on catheters with low dexterity and high aspect ratios to reach an anatomical target. However, the environment inside the beating heart presents a combination of challenges unique to few anatomic locations, making it difficult for interventional tools to maneuver dexterously and apply substantial forces on an intracardiac target. We demonstrate a millimeter-scale soft robotic platform that can deploy and self-stabilize at the entrance to the heart, and guide existing interventional tools toward a target site. In two exemplar intracardiac procedures within the right atrium, the robotic platform provides enough dexterity to reach multiple anatomical targets, enough stability to maintain constant contact on motile targets, and enough mechanical leverage to generate newton-level forces. Because the device addresses ongoing challenges in minimally invasive intracardiac intervention, it may enable the further development of catheter-based interventions.
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Affiliation(s)
- Jacob Rogatinsky
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Dominic Recco
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | | | - Yuchen Kang
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Nicholas Kneier
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Peter Hammer
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Edward O’Leary
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Douglas Mah
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - David Hoganson
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Nikolay V. Vasilyev
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Tommaso Ranzani
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
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Bydlon TM, Torjesen A, Fokkenrood S, Di Tullio A, Flexman ML. 3D Visualisation of Navigation Catheters for Endovascular Procedures Using a 3D Hub and Fiber Optic RealShape Technology: Phantom Study Results. EJVES Vasc Forum 2023; 59:24-30. [PMID: 37389371 PMCID: PMC10300314 DOI: 10.1016/j.ejvsvf.2023.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/23/2023] [Accepted: 05/09/2023] [Indexed: 07/01/2023] Open
Abstract
Objective Fiber Optic RealShape (FORS) is a new technology that visualises the full three dimensional (3D) shape of guidewires using an optical fibre embedded in the device. Co-registering FORS guidewires with anatomical images, such as a digital subtraction angiography (DSA), provides anatomical context for navigating these devices during endovascular procedures. The objective of this study was to demonstrate the feasibility and usability of visualising compatible conventional navigation catheters, together with the FORS guidewire, in phantom with a new 3D Hub technology and to understand potential clinical benefits. Methods The accuracy of localising the 3D Hub and catheter in relation to the FORS guidewire, was evaluated using a translation stage test setup and a retrospective analysis of prior clinical data. Catheter visualisation accuracy and navigation success was assessed in a phantom study where 15 interventionists navigated devices to three pre-defined targets in an abdominal aortic phantom using an Xray or computed tomography angiography (CTA) roadmap. Additionally, the interventionists were surveyed about the usability and potential benefits of the 3D Hub. Results The location of the 3D Hub and catheter along the FORS guidewire was detected correctly 96.59% of the time. During the phantom study, all 15 interventionists successfully reached the target locations 100% of the time and the error in catheter visualisation was 0.69 mm. The interventionists agreed or strongly agreed that the 3D Hub was easy to use and the greatest potential clinical benefit over FORS is in offering interventionists choice over which catheter they used. Conclusion This set of studies has shown that FORS guided catheter visualisation, enabled by a 3D Hub, is accurate and easy to use in a phantom setting. Further evaluation is needed to understand the benefits and limitations of the 3D Hub technology during endovascular procedures.
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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] [MESH Headings] [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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Innovation, disruptive Technologien und Transformation in der Gefäßchirurgie. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Geisler A, Schmidt A, Branzan D. [Digital Patient Data, Artificial Intelligence and Machine Learning in the New Era of Endovascular Aortic Therapies]. Zentralbl Chir 2022; 147:432-438. [PMID: 36220064 DOI: 10.1055/a-1938-8227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Antonia Geisler
- Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Andrej Schmidt
- Interventionelle Angiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Daniela Branzan
- Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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10
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Condino S, Piazza R, Carbone M, Bath J, Troisi N, Ferrari M, Berchiolli R. Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review. Front Surg 2022; 9:966118. [PMID: 36061062 PMCID: PMC9437582 DOI: 10.3389/fsurg.2022.966118] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/04/2022] [Indexed: 12/20/2022] Open
Abstract
Biomedical engineering integrates a variety of applied sciences with life sciences to improve human health and reduce the invasiveness of surgical procedures. Technological advances, achieved through biomedical engineering, have contributed to significant improvements in the field of vascular and endovascular surgery. This paper aims to review the most cutting-edge technologies of the last decade involving the use of augmented reality devices and robotic systems in vascular surgery, highlighting benefits and limitations. Accordingly, two distinct literature surveys were conducted through the PubMed database: the first review provides a comprehensive assessment of augmented reality technologies, including the different techniques available for the visualization of virtual content (11 papers revised); the second review collects studies with bioengineering content that highlight the research trend in robotic vascular surgery, excluding works focused only on the clinical use of commercially available robotic systems (15 papers revised). Technological flow is constant and further advances in imaging techniques and hardware components will inevitably bring new tools for a clinical translation of innovative therapeutic strategies in vascular surgery.
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Affiliation(s)
- Sara Condino
- Department of Information Engineering, University of Pisa, Pisa, Italy
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberta Piazza
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marina Carbone
- Department of Information Engineering, University of Pisa, Pisa, Italy
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Correspondence: Marina Carbone
| | - Jonathan Bath
- Division of Vascular Surgery, University of Missouri, Columbia, MO, United States
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mauro Ferrari
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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