Remote Surgery Using a Neuroendovascular Intervention Support Robot Equipped with a Sensing Function: Experimental Verification

Perspectives on Remote Robotic-Assisted Stroke Treatment: A Commentary Paper

The proved feasibility of robotic-assisted endovascular treatment of intracranial aneurysms has stimulated the idea of a potential application of remote robotics for the treatment of acute ischemic stroke. The possibility of developing a more advanced remote-controlled robotic system capable of performing a complete mechanical thrombectomy procedure would help bridge the health care gap of lack of technical expertise in isolated areas. This possibility could allow a more equitable access to mechanical thrombectomy to a larger number of patients and be a breakthrough for acute ischemic stroke care worldwide. Many aspects around the technical, human, financial, and regulatory requirements should be discussed to implement remote robotic-assisted procedures. In this State of Practice article, we aimed to outline the major challenges that must be considered, as well as proposed solutions. However, different solutions may be applied in different health care systems on the basis of the availability of human and financial resources.

The implications of 5G technology on cardiothoracic surgical services in India

The fifth-generation (5G) technology is finally making its long-anticipated arrival in India, where it has evoked much hope to advance healthcare accessibility and delivery to the masses as well as improving patient safety and efficiency. The 5G technology standard for broadband and cellular networks comes with improved coverage capability; better throughput, speed, bandwidth, and signal strength; and low latency. Such salient-advanced features could be the knight in shining armor for the cardiothoracic surgical community in bridging gaps in perioperative care, outreach, education, research, and much more.

Development of a Force Sensor for a Neuroendovascular Intervention Support Robot System

Neuroendovascular catheterization using fluoroscopy poses the problem to operators and staffs of cumulative radiation exposure. To solve this problem, we are developing a remote-controlled master-slave robot. Because a wire-like elongated treatment device is inserted into a blood vessel using a catheter, the robot requires a sensor to detect the insertion force of the wire. The proposed sensor is integrated into a robot installed in an X-ray fluoroscopy room that is remotely controlled from another room. The features of this sensor include measurement of the insertion force with sufficient accuracy, simple wire attachment, and an inexpensive disposable sensor head, rendering it very suitable for practical application. In this paper, we report on these features, as well as the results of a practical test of the sensor using a cerebrovascular model.

Pilot Animal Study on Robotic-Assisted Endovascular Visceral Interventions

Purpose

To evaluate technical feasibility and safety of common endovascular visceral interventions using a vascular robotic platform through preclinical study.

Material and Methods

The CorPath GRX Robotic System (Corindus Inc, Waltham, Massachusetts) was tested in an anesthetized pig for its ability to navigate various commercially available devices in the abdominal vasculature and to perform routine endovascular visceral procedures. After manually placing a guiding catheter in the celiac trunk, several visceral branches were probed with microcatheters and -wires under robotic assistance, and embolization with liquids (lipiodol), detachable coils and plugs were performed. Furthermore, the origin of the celiac trunk was stented before accessing the left hypogastric artery for pelvic embolization.

Results

All procedures were performed with technical success and without any complications. Navigating the catheters and wires via the steering console proved intuitive. Coil, plug and stent deployment were exclusively controlled by remote with remarkable precision and stability.

Conclusion

Robotic-assisted visceral embolization and stenting as well as pelvic embolization using the CorPath GRX System is feasible and safe. Application of the platform in the abdominal vasculature is demonstrated for the first time. Considering the precision and the potential for reducing the operator’s radiation exposure, further research in this area is highly encouraged to enable translation into clinical practice.

Robotics and Artificial Intelligence in Endovascular Neurosurgery

The use of artificial intelligence (AI) and robotics in endovascular neurosurgery promises to transform neurovascular care. We present a review of the recently published neurosurgical literature on artificial intelligence and robotics in endovascular neurosurgery to provide insights into the current advances and applications of this technology.

The PubMed database was searched for "neurosurgery" OR "endovascular" OR "interventional" AND "robotics" OR "artificial intelligence" between January 2016 and August 2021. A total of 1296 articles were identified, and after applying the inclusion and exclusion criteria, 38 manuscripts were selected for review and analysis. These manuscripts were divided into four categories: 1) robotics and AI for the diagnosis of cerebrovascular pathology, 2) robotics and AI for the treatment of cerebrovascular pathology, 3) robotics and AI for training in neuroendovascular procedures, and 4) robotics and AI for clinical outcome optimization.

The 38 articles presented include 23 articles on AI-based diagnosis of cerebrovascular disease, 10 articles on AI-based treatment of cerebrovascular disease, two articles on AI-based training techniques for neuroendovascular procedures, and three articles reporting AI prediction models of clinical outcomes in vascular disorders of the brain. Innovation with robotics and AI focus on diagnostic efficiency, optimizing treatment and interventional procedures, improving physician procedural performance, and predicting clinical outcomes with the use of artificial intelligence and robotics. Experimental studies with robotic systems have demonstrated safety and efficacy in treating cerebrovascular disorders, and novel microcatheterization techniques may permit access to deeper brain regions. Other studies show that pre-procedural simulations increase overall physician performance. Artificial intelligence also shows superiority over existing statistical tools in predicting clinical outcomes.

The recent advances and current usage of robotics and AI in the endovascular neurosurgery field suggest that the collaboration between physicians and machines has a bright future for the improvement of patient care. The aim of this work is to equip the medical readership, in particular the neurosurgical specialty, with tools to better understand and apply findings from research on artificial intelligence and robotics in endovascular neurosurgery.