1
|
Morrison JD, Joshi KC, Beer Furlan A, Kolb B, Radaideh Y, Munich S, Crowley W, Chen M. Feasibility of robotic neuroendovascular surgery. Interv Neuroradiol 2023:15910199221097898. [PMID: 37543370 DOI: 10.1177/15910199221097898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Several recent reports of CorPath GRX vascular robot (Cordinus Vascular Robotics, Natick, MA) use intracranially suggest feasibility of neuroendovascular application. Further use and development is likely. During this progression it is important to understand endovascular robot feasibility principles established in cardiac and peripheral vascular literature which enabled extension intracranially. Identification and discussion of robotic proof of concept principals from sister disciplines may help guide safe and accountable neuroendovascular application. OBJECTIVE Summarize endovascular robotic feasibility principals established in cardiac and peripheral vascular literature relevant to neuroendovascular application. METHODS Searches of PubMed, Scopus and Google Scholar were conducted under PRISMA guidelines1 using MeSH search terms. Abstracts were uploaded to Covidence citation review (Covidence, Melbourne, AUS) using RIS format. Pertinent articles underwent full text review and findings are presented in narrative and tabular format. RESULTS Search terms generated 1642 articles; 177, 265 and 1200 results for PubMed, Scopus and Google Scholar respectively. With duplicates removed, title review identified 176 abstracts. 55 articles were included, 45 from primary review and 10 identified during literature review. As it pertained to endovascular robotic feasibility proof of concept 12 cardiac, 3 peripheral vascular and 5 neuroendovascular studies were identified. CONCLUSIONS Cardiac and peripheral vascular literature established endovascular robot feasibility and efficacy with equivalent to superior outcomes after short learning curves while reducing radiation exposure >95% for the primary operator. Limitations of cost, lack of haptic integration and coaxial system control continue, but as it stands neuroendovascular robotic implementation is worth continued investigation.
Collapse
Affiliation(s)
- Joseph D Morrison
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Krishna C Joshi
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Andre Beer Furlan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Bradley Kolb
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Yazan Radaideh
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Stephan Munich
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Webster Crowley
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael Chen
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
2
|
Duan W, Akinyemi T, Du W, Ma J, Chen X, Wang F, Omisore O, Luo J, Wang H, Wang L. Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review. MICROMACHINES 2023; 14:197. [PMID: 36677258 PMCID: PMC9864595 DOI: 10.3390/mi14010197] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Prior methods of patient care have changed in recent years due to the availability of minimally invasive surgical platforms for endovascular interventions. These platforms have demonstrated the ability to improve patients' vascular intervention outcomes, and global morbidities and mortalities from vascular disease are decreasing. Nonetheless, there are still concerns about the long-term effects of exposing interventionalists and patients to the operational hazards in the cath lab, and the perioperative risks that patients undergo. For these reasons, robot-assisted vascular interventions were developed to provide interventionalists with the ability to perform minimally invasive procedures with improved surgical workflow. We conducted a thorough literature search and presented a review of 130 studies published within the last 20 years that focused on robot-assisted endovascular interventions and are closely related to the current gains and obstacles of vascular interventional robots published up to 2022. We assessed both the research-based prototypes and commercial products, with an emphasis on their technical characteristics and application domains. Furthermore, we outlined how the robotic platforms enhanced both surgeons' and patients' perioperative experiences of robot-assisted vascular interventions. Finally, we summarized our findings and proposed three key milestones that could improve the development of the next-generation vascular interventional robots.
Collapse
Affiliation(s)
- Wenke Duan
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Toluwanimi Akinyemi
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Wenjing Du
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jun Ma
- Shenzhen Raysight Intelligent Medical Technology Co., Ltd., Shenzhen 518063, China
| | - Xingyu Chen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Fuhao Wang
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Olatunji Omisore
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Shenzhen Engineering Laboratory for Diagnosis & Treatment Key Technologies of Interventional Surgical Robots, Shenzhen 518055, China
| | - Jingjing Luo
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Hongbo Wang
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Lei Wang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Shenzhen Engineering Laboratory for Diagnosis & Treatment Key Technologies of Interventional Surgical Robots, Shenzhen 518055, China
| |
Collapse
|
3
|
Pancholy SB, Payne M, Pancholy PS, Patel GA, Patel S, Shah SC, Kaul P, Pancholy SA, Patel TM. Association between distance from the radiation source and radiation exposure: A phantom-based study. Catheter Cardiovasc Interv 2021; 97:E810-E816. [PMID: 32881383 DOI: 10.1002/ccd.29223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/19/2020] [Accepted: 08/08/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The study evaluated the association between distance from radiation source and radiation exposure. BACKGROUND Radiation exposure during medical procedures is associated with increased risk of cancer and other adverse effects. METHODS An American National Standards Institute phantom was used to study the relationship between measured entrance surface exposure (MESE) and distance from the X-ray source in postero-anterior, left anterior oblique, and right anterior oblique projections. Three distance settings for table height were evaluated with "low" defined as 52 cm, "mid" 66 cm, and "high" 80 cm from the focal point of the X-ray source. Air-kerma and dose-area product measurements were recorded. Operator exposure with each of these conditions was measured, in a short operator (150 cm) as well as in a tall operator (190 cm). RESULTS Aggregate results for the three projections were as follows. MESE (μGy/frame) significantly decreased as table-height increases (median, interquartile range, p-value) (low table-height 192.5 [122.4-201.2], mid table-height 105.8 [82.7-115.8], and high table-height 71.7 [58.4-75], p < .0005). The operator exposure (μGy/frame), significantly increased as the table-height increased (low table-height 0.0943 [0.0598-0.1157], medium table-height 0.1128 [0.0919-0.1397], and high table-height 0.158 [0.1339-0.2165], p < .0005). A shorter operator received higher radiation exposure compared to a taller operator (short operator 0.1405 [0.1155-0.1758] and tall operator 0.0995 [0.0798-0.1212], p < .0005). CONCLUSIONS Increasing table-height is associated with a significant decrease in MESE. Operator radiation exposure increases with increasing table-height and shorter operators receive greater radiation exposure compared to taller operators.
Collapse
Affiliation(s)
- Samir B Pancholy
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Michael Payne
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | | | - Gaurav A Patel
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Saurabh Patel
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | | | | | - Shivam A Pancholy
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | | |
Collapse
|
4
|
Jolaei M, Hooshiar A, Sayadi A, Dargahi J, Packirisamy M. Sensor-free Force Control of Tendon-driven Ablation Catheters through Position Control and Contact Modeling. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5248-5251. [PMID: 33019168 DOI: 10.1109/embc44109.2020.9176019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the present study, a sensor-free force control framework for tendon-driven steerable catheters was proposed and validated. The hypothesis of this study was that the contact force between the catheter tip and the tissue could be controlled using the estimated force with a previously validated displacement-based viscoelastic tissue model. The tissue model was used in a feedback control loop. The model estimated the contact force based on a realtime estimation of catheter-tissue indentation depth performed by a data-driven inverse kinematic model. To test the hypothesis, a tendon-driven catheter (φ6 × 40mm) and a robotic catheter intervention system were prototyped and characterized. Three validation studies were performed to test the performance of the proposed system with static and dynamic inputs. The results showed that the system was capable of reaching to the desired force with a root-mean-square error of 0.03 ± 0.02N for static tests and 0.05 ± 0.04N for dynamic inputs. The main contribution of this study was providing a computationally efficient and sensor-free force control schema for tendon-driven catheters.
Collapse
|
5
|
Weinberg JH, Sweid A, Sajja K, Gooch MR, Herial N, Tjoumakaris S, Rosenwasser RH, Jabbour P. Comparison of robotic-assisted carotid stenting and manual carotid stenting through the transradial approach. J Neurosurg 2020; 135:21-28. [PMID: 32858520 DOI: 10.3171/2020.5.jns201421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to demonstrate the feasibility and safety of CorPath GRX robotic-assisted (RA) transradial (TR) carotid artery stenting (CAS) compared with manual TR CAS. METHODS The authors conducted a retrospective analysis of a prospectively maintained database and identified 13 consecutive patients who underwent TR CAS from June 2019 through February 2020. Patients were divided into 2 groups: RA (6 patients) and manual (7 patients). RESULTS Among 6 patients in the RA group with a mean age of 70.0 ± 7.2 years, technical success was achieved in all 6 (100%) procedures; there were no technical or access-site complications and no catheter exchanges. Transfemoral conversion was required in 1 (16.7%) case due to a tortuous aortic arch. There were no perioperative complications, including myocardial infarction, stroke, and mortality. The mean procedure duration was significantly longer in the RA group (85.0 ± 14.3 minutes [95% CI 69.9-100.0] vs 61.2 ± 17.5 minutes [95% CI 45.0-77.4], p = 0.0231). There was no significant difference in baseline characteristics, fluoroscopy time, contrast dose, radiation exposure, catheter exchanges, technical success, transfemoral conversion, technical or access-site complications, myocardial infarction, stroke, other complications, or mortality. CONCLUSIONS The authors' results suggest that RA TR CAS is feasible, safe, and effective. Neurovascular-specific engineering and software modifications are needed prior to complete remote control. Remote control has important implications regarding patient access to lifesaving procedures for conditions such as stroke and aneurysm rupture as well as operative precision. Future clinical investigations among larger cohorts are needed to demonstrate reliable performance and patient benefit.
Collapse
|
6
|
Jolaei M, Hooshiar A, Dargahi J, Packirisamy M. Toward Task Autonomy in Robotic Cardiac Ablation: Learning-Based Kinematic Control of Soft Tendon-Driven Catheters. Soft Robot 2020; 8:340-351. [PMID: 32678722 DOI: 10.1089/soro.2020.0006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The goal of this study was to propose and validate a control framework with level-2 autonomy (task autonomy) for the control of flexible ablation catheters. To this end, a kinematic model for the flexible portion of typical ablation catheters was developed and a 40-mm-long spring-loaded flexible catheter was fabricated. The feasible space of the catheter was obtained experimentally. Furthermore, a robotic catheter intervention system was prototyped for controlling the length of the catheter tendons. The proposed control framework used a support vector machine classifier to determine the tendons to be driven, and a fully connected neural network regressor to determine the length of the tendons. The classifier and regressors were trained with the data from the feasible space. The control system was implemented in parallel at user-interface and firmware and exhibited a 0.4-s lag in following the input. The validation studies were four trajectory tracking and four target reaching experiments. The system was capable of tracking trajectories with an error of 0.49 ± 0.32 and 0.62 ± 0.36 mm in slow and fast trajectories, respectively. Also, it exhibited submillimeter accuracy in reaching three preplanned targets and ruling out one nonfeasible target autonomously. The results showed improved accuracy and repeatability of the position control compared with the recent literature. The proposed learning-based approach could be used in enabling task autonomy for catheter-based ablation therapies.
Collapse
Affiliation(s)
- Mohammad Jolaei
- Robotic Surgery Laboratory and Mechanical, Industrial, and Aerospace Engineering Department, Concordia University, Montreal, Canada.,Optical Bio-microsystems Laboratory, Mechanical, Industrial, and Aerospace Engineering Department, Concordia University, Montreal, Canada
| | - Amir Hooshiar
- Robotic Surgery Laboratory and Mechanical, Industrial, and Aerospace Engineering Department, Concordia University, Montreal, Canada
| | - Javad Dargahi
- Robotic Surgery Laboratory and Mechanical, Industrial, and Aerospace Engineering Department, Concordia University, Montreal, Canada
| | - Muthukumaran Packirisamy
- Optical Bio-microsystems Laboratory, Mechanical, Industrial, and Aerospace Engineering Department, Concordia University, Montreal, Canada
| |
Collapse
|
7
|
Anuwatworn A, Ali Kahn M, Stys T, Petrasko M, Stys A. Robotic-Assisted Percutaneous Coronary Intervention Through Transradial Approach: Experience in 4 Patients with Complex Lesions. Tex Heart Inst J 2020; 47:144-148. [PMID: 32603464 DOI: 10.14503/thij-17-6350] [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] [Indexed: 12/22/2022]
Abstract
Robotic-assisted percutaneous coronary intervention can reduce the exposure of interventional cardiologists to radiation and minimize the risk of occupational orthopedic injuries from wearing heavy protective aprons. The PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention) study showed the efficacy and safety of robotic-assisted procedures for relatively low-risk lesions in single coronary arteries. Several reports have described robotic-assisted treatment of complex high-risk lesions, mostly through the transfemoral approach. We report 4 cases of patients in whom we used the transradial approach to treat complex lesions in the left anterior descending coronary artery with bifurcation balloon angioplasty reconstruction (2 cases), in the ostium of the first diagonal branch, and in the right coronary artery.
Collapse
Affiliation(s)
- Amornpol Anuwatworn
- Department of Internal Medicine, Sanford Cardiovascular Institute, Sanford USD Medical Center, University of South Dakota-Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Muhammad Ali Kahn
- Department of Internal Medicine, Sanford Cardiovascular Institute, Sanford USD Medical Center, University of South Dakota-Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Tomasz Stys
- Department of Internal Medicine, Sanford Cardiovascular Institute, Sanford USD Medical Center, University of South Dakota-Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Marian Petrasko
- Department of Internal Medicine, Sanford Cardiovascular Institute, Sanford USD Medical Center, University of South Dakota-Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Adam Stys
- Department of Internal Medicine, Sanford Cardiovascular Institute, Sanford USD Medical Center, University of South Dakota-Sanford School of Medicine, Sioux Falls, South Dakota 57105
| |
Collapse
|
8
|
Liounakos JI, Urakov T, Wang MY. Head-up display assisted endoscopic lumbar discectomy-A technical note. Int J Med Robot 2020; 16:e2089. [PMID: 32034967 DOI: 10.1002/rcs.2089] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Minimally invasive surgery is heavily dependent on indirect visualization and image guidance, often resulting in non-ergonomic postures. Minimally invasive surgeons are more likely to experience neck pain, shoulder pain, and fatigue compared to open surgeons. Spinal endoscopy is rapidly increasing in popularity among minimally invasive spine surgeons. A primary ergonomic issue is the position of the endoscope display, which is often not in line with the operative field or the surgeon's natural line of sight. METHODS Smart glasses providing a head-up display are used in a case of percutaneous endoscopic lumbar discectomy to bring the surgeon's line of sight into parallel with the operative field. RESULTS Bringing the surgeon's visual and motor axes into parallel resulted in a more comfortable and ergonomic operating position. CONCLUSIONS Head-up displays may provide an elegant and relatively simple solution to the issue of inadequate ergonomics in minimally invasive surgery.
Collapse
Affiliation(s)
- Jason I Liounakos
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Timur Urakov
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW To review the contemporary evidence for robotic-assisted percutaneous coronary and vascular interventions, discussing its current capabilities, limitations, and potential future applications. RECENT FINDINGS Robotic-assisted cardiovascular interventions significantly reduce radiation exposure and orthopedic strains for interventionalists, while maintaining high rates of device and clinical success. The PRECISE and CORA-PCI studies demonstrated the safety and efficacy of robotic-assisted percutaneous coronary intervention (PCI) in increasingly complex coronary lesions. The RAPID study demonstrated similar findings in peripheral vascular interventions (PVI). Subsequent studies have demonstrated the safety and efficacy of second-generation devices, with automations mimicking manual PCI techniques. While innovations such as telestenting continue to bring excitement to the field, major limitations remain-particularly the lack of randomized trials comparing robotic-assisted PCI with manual PCI. Robotic technology has successfully been applied to multiple cardiovascular procedures. There are limited data to evaluate outcomes with robotic-assisted PCI and other robotic-assisted cardiovascular procedures, but existing data show some promise of improving the precision of PCI while decreasing occupational hazards associated with radiation exposure.
Collapse
Affiliation(s)
- Zachary K Wegermann
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Sunil V Rao
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| |
Collapse
|
10
|
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.
Collapse
|
11
|
Lo N, Gutierrez JA, Swaminathan RV. Robotic-Assisted Percutaneous Coronary Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:14. [DOI: 10.1007/s11936-018-0608-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|