An intelligent catheter system robotic controlled catheter system

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

INTRODUCTION

Robotics could expand treatment of rapidly progressive pathologies such as acute ischemic stroke, with the potential to provide populations in need prompt access to neuro-endovascular procedures.

METHODS

Robotically-assisted (RA) neuro-endovascular procedures (RANPs) performed at our institution were retrospectively examined (RA-group, RG). A control group of manual neuro-endovascular procedures was selected (manual group, MG). Total operating room (OR) time, procedural time, contrast media use, fluoroscopy time, conversion from RA to manual control, procedural success, and complication rates were compared. A learning curve was identified.

RESULTS

Forty-one (41) RANPs were analyzed. Ages ranged from 20-82 y.o. Indications included diagnostic cerebral angiography (37), extracranial carotid artery stenting (3), and transverse sinus stent (1). Total OR time was longer in RG (median 86 vs. 71 min, p < 0.01). Procedural time (median 56 vs. 45 min, p = 0.12), fluoroscopy time (median 12 vs. 12 min, p = 0.69) and contrast media usage (82 vs. 92 ml, p = 0.54) were not significantly different. Patient radiation exposure was similar, considering similar fluoroscopy times. Radiation exposure and lead apron use were virtually absent for the main surgeon in RG. Procedural success was 83% and conversion from RA to manual control was 17% in RG. No treatment-related complications occurred. A learning curve showed that, after the fifth procedure, procedural times reduced and stabilized.

CONCLUSIONS

This series may contribute to further demonstrating the safety and feasibility of RANPs. RANPs can potentially reduce radiation exposure and physical burden for health personnel, expand acute cerebrovascular treatment to underserved areas, and enhance telementoring. Prospective studies are necessary for results to be generalized.

Objective performance metrics in human robotic neuroendovascular interventions: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to review the available information on objective performance metrics used during robotic neuroendovascular intervention procedures on humans.

INTRODUCTION

Robotic neuroendovascular intervention is defined as any endovascular procedure within the vasculature of the central nervous system with the assistance of a robotic system for diagnostic or therapeutic procedures. Robotic systems are described as a 2-component system consisting of a patient-side mechanical robot, and a separate operator control station. Robotic neuroendovascular intervention is a growing field and there is a need to establish objective performance metrics for furthering evidence-based reporting of the literature.

INCLUSION CRITERIA

This scoping review will consider all studies involving humans that utilize robotic neuroendovascular intervention. We will consider all types of studies, reports, and reviews as well as gray literature. Studies will be included if they describe the use of an objective performance metric during robotic neuroendovascular intervention. This review is not limited to a particular country or health care system, and will consider all study designs, regardless of their rigor or language.

METHODS

Utilizing a 3-step framework as a guide, we will perform a systematic search in Embase, Cochrane Library, and MEDLINE. Available literature from inception to the present will be considered. Studies will be independently screened according to the inclusion criteria by 2 reviewers based on title, abstract, and full text. Data will be extracted, sorted, and presented in both a narrative summary as well as table and diagram based on the objective of the scoping review.

A Review of Robotic Interventional Neuroradiology

Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a lead-shielded cockpit located several feet (or potentially hundreds of miles) from the patient. This has opened up the possibility of expanding telestroke networks to patients without access to life-saving procedures such as stroke thrombectomy and cerebral aneurysm occlusion by highly-experienced physicians. The prototype machines, first developed in the early 2000s, have evolved into machines capable of a broad range of techniques, while incorporating newly automated maneuvers and safety algorithms. In recent years, preliminary clinical research has been published demonstrating the safety and feasibility of the technology in cerebral angiography and intracranial intervention. The next step is to conduct larger, multisite, prospective studies to assess generalizability and, ultimately, improve patient outcomes in neurovascular disease.

Novel Operation Support Robot with Sensory-Motor Feedback System for Neuroendovascular Intervention

BACKGROUND

Robotic technology is rapidly developing in the medical field, particularly contributing to support operative intervention using the da Vinci system during endoscopic surgery. Neuroendovascular intervention robot surgery is preferred when aiming to reduce radiation exposure among surgeons.

METHODS

We developed a prototype of a support robot with 2 independent slaves manipulating both the microcatheter and microguidewire connected with the remote master driver with 2 joysticks. This design simulates usual catheterization with both hands. The slave manipulator has a sufficient output force >1 N to reproduce the exact master intervention without slip and delay. This machine has a unique function that indicates the reaction force of the resistance on wire stuck using the sensor system. We investigated the master-slave response, reliability of the force gauge, and degree of slippage of the slave motion on the table and checked the controllability, safety, and reproducibility of microcatheterization and insertion maneuver into the experimental aneurysm in the in vivo silicone vessel model.

RESULTS

We realized the well master-slave response with a stable driving speed of the microguidewire at approximately 1 mm/s and with linear correlation between the output voltage and driving force. Also, we confirmed the well safety function to avoid the overloading to the vascular wall with the slippage of the slave roller on loading >1 N pushing force. Successful microcatheterization and insertion into the aneurysm model was performed in the wet vascular model corresponding to the 3-dimensional handling without excessive stress to the vascular or aneurysmal wall.

CONCLUSIONS

Neuroendovascular intervention requires delicate power adjustment with fine finger control. Our support robot for neuroendovascular interventions demonstrated the accurate reproducibility of the operator's maneuver and safe operation in the vascular model using the sensor system. This system will realize the neurointervention without human operators in the AngioSuite and may facilitate telesurgery with remote control in the near future.

A marker-based contactless catheter-sensing method to detect surgeons' operations for catheterization training systems

It is challenging to position a catheter or a guidewire within a patient's complicated and delicate vascular structure due to the lack of intuitive visual feedback by only manipulating the proximal part of the surgical instruments. Training is therefore critical before an actual surgery because any mistake due to the surgeon's inexperience can be fatal for the patient. The catheter manipulation skills of experienced surgeons can be useful as input for training novice surgeons. However, few research groups focused on designs with consideration of the contactless catheter motion measurement, which allows obtaining expert surgeons' catheter manipulation trajectories whilst still allowing them to employ an actual catheter and apply conventional pull, push and twist of the catheter as used in bedside intravascular interventional surgeries. In this paper, a novel contactless catheter-sensing method is proposed to measure the catheter motions by detecting and tracking a passive marker with four feature-point groups. The passive marker is designed to allow simultaneously sensing the translational and rotational motions of the input catheter. Finally, the effectiveness of the proposed contactless catheter-sensing method is validated by conducting a series of comparison experiments. The accuracy and error analysis are quantified based on the absolute error, relative error, mean absolute error, and the success rate of the detection.

Design and performance evaluation of a master controller for endovascular catheterization

PURPOSE

It is difficult to manipulate a flexible catheter to target a position within a patient's complicated and delicate vessels. However, few researchers focused on the controller designs with much consideration of the natural catheter manipulation skills obtained from manual catheterization. Also, the existing catheter motion measurement methods probably lead to the difficulties in designing the force feedback device. Additionally, the commercially available systems are too expensive which makes them cost prohibitive to most hospitals. This paper presents a simple and cost-effective master controller for endovascular catheterization that can allow the interventionalists to apply the conventional pull, push and twist of the catheter used in current practice.

METHODS

A catheter-sensing unit (used to measure the motion of the catheter) and a force feedback unit (used to provide a sense of resistance force) are both presented. A camera was used to allow a contactless measurement avoiding additional friction, and the force feedback in the axial direction was provided by the magnetic force generated between the permanent magnets and the powered coil.

RESULTS

Performance evaluation of the controller was evaluated by first conducting comparison experiments to quantify the accuracy of the catheter-sensing unit, and then conducting several experiments to evaluate the force feedback unit. From the experimental results, the minimum and the maximum errors of translational displacement were 0.003 mm (0.01 %) and 0.425 mm (1.06 %), respectively. The average error was 0.113 mm (0.28 %). In terms of rotational angles, the minimum and the maximum errors were 0.39°(0.33 %) and 7.2°(6 %), respectively. The average error was 3.61°(3.01 %). The force resolution was approximately 25 mN and a maximum current of 3A generated an approximately 1.5 N force.

CONCLUSION

Based on analysis of requirements and state-of-the-art computer-assisted and robot-assisted training systems for endovascular catheterization, a new master controller with force feedback interface was proposed to maintain the natural endovascular catheterization skills of the interventionalists.

Medico-financial Environment on Treatment for Acutely Ruptured Cerebral Aneurysms. GDC Embolization vs Neck Clipping

SUMMARY

We have been using the Guglielmi detachable coils (GDC) since 1997 as one choice of cerebral aneurysm treatment.We have, at the present time, two effective radical treatment methods for acutely ruptured cerebral aneurysms, GDC embolization and conventional surgical aneurysmal neck clipping. There ensued questions about the cost and efficacy of the two strategies. Retrospective analysis was done on a GDC group and a clipping group, with each twenty consecutive patients. The features of the GDC group patients were higher age, and poorer Hunt and Kosnik grades than the other group. All MCA aneurysms were treated with surgical neck clipping, while all the posterior circulation aneurysms were embolized with GDC. Based on the Japanese Medical Insurance and Payment System, 477,890 points (1 point = yen 10) as a mean was required with the GDC group, and 456,084 points with the neck clipping group, showing no significant difference between the two groups. In the GDC group, the cost of the implanted medical device seemed to raise the total medical expense. At present, the GDC embolization is the preferred choice of strategies in acutely ruptured cerebral aneurysms, and its preference increases in the surgically difficult cases, very old, or poor grade patients, and in various complicated cases. And, the GDC embolization seems to be satisfactory from the medico-financial viewpoint.