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Mendes Pereira V, Rice H, De Villiers L, Sourour N, Clarencon F, Spears J, Tomasello A, Hernandez D, Cancelliere NM, Liu XYE, Nicholson P, Costalat V, Gascou G, Mordasini P, Gralla J, Martínez-Galdámez M, Galvan Fernandez J, Killer-Oberpfalzer M, Liebeskind DS, Turner RD, Blanc R, Piotin M. Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms. J Neurointerv Surg 2024; 16:405-411. [PMID: 37793795 PMCID: PMC10958306 DOI: 10.1136/jnis-2023-020161] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. OBJECTIVE To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. METHODS This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling and/or stent-assisted coiling. The primary effectiveness endpoint was defined as successful completion of the robotic-assisted endovascular procedure without any unplanned conversion to manual treatment with guidewire or microcatheter navigation, embolization coil(s) or intracranial stent(s) deployment, or an inability to navigate vessel anatomy. The primary safety endpoint included intraprocedural and periprocedural events. RESULTS The study enrolled 117 patients (74.4% female) with mean age of 56.6 years from 10 international sites,. Headache was the most common presenting symptom in 40/117 (34.2%) subjects. Internal carotid artery was the most common location (34/122, 27.9%), and the mean aneurysm height and neck width were 5.7±2.6 mm and 3.5±1.4 mm, respectively. The overall procedure time was 117.3±47.3 min with 59.4±32.6 min robotic procedure time. Primary effectiveness was achieved in 110/117 (94%) subjects with seven subjects requiring conversion to manual for procedure completion. Only four primary safety events were recorded with two intraprocedural aneurysm ruptures and two strokes. A Raymond-Roy Classification Scale score of 1 was achieved in 71/110 (64.5%) subjects, and all subjects were discharged with a modified Rankin Scale score of ≤2. CONCLUSIONS This first-of-its-kind robotic-assisted neurovascular trial demonstrates the effectiveness and safety of the CorPath GRX System for endovascular embolization of cerebral aneurysm procedures. TRIAL REGISTRATION NUMBER NCT04236856.
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Affiliation(s)
- Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hal Rice
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia De Villiers
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nader Sourour
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Frédéric Clarencon
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Tomasello
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - David Hernandez
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Nicole M Cancelliere
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Yu Eileen Liu
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jorge Galvan Fernandez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Raymond D Turner
- Division of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
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2
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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.
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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
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3
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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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4
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E T, K G, P S, Afrin SA, R K. Robotic Percutaneous Coronary Intervention (R-PCI): Time to Focus on the Pros and Cons. Indian Heart J 2023:S0019-4832(23)00070-6. [PMID: 37080484 DOI: 10.1016/j.ihj.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/12/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023] Open
Abstract
AIM To assess the safety, efficiency, and device compatibility of the Second Generation Robotic System. METHODS Data on Robot-Assisted PCI (R-PCI) is frequently insufficient in India. Many articles were published in national, non-indexed journals that are not available online and are difficult to obtain. Recognizing these constraints, the current review is intended to compile the available data on this important new innovation technique. This review could encourage future research and serve as a valuable source of information. RESULTS /Conclusion: In terms of procedure efficiency, operator radiation reduction, and safety, the recent implementation and development of second-generation robotic systems have had a significant impact on interventional cardiology. This technology will play a significant role in the future of interventional cardiology as advancements eliminate the need for manual assistance, improve devices compatibility, and expand the use of robotics for telestenting procedures. A larger study demonstrating the safety and feasibility of tele-stenting over greater geographic distances, as well as addressing fundamental technical difficulties, would be required before attempting R-PCI.
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Affiliation(s)
- Thirumurugan E
- Srinivas University, India; College of Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu.
| | - Gomathi K
- College of Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu.
| | - Swathy P
- College of Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu.
| | - Syed Ali Afrin
- College of Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu.
| | - Karthick R
- College of Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu.
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5
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Design and evaluation of vascular interventional robot system for complex coronary artery lesions. Med Biol Eng Comput 2023; 61:1365-1380. [PMID: 36705768 DOI: 10.1007/s11517-023-02775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
At present, most vascular intervention robots cannot cope with the more common coronary complex lesions in the clinic. Moreover, the lack of effective force feedback increases the risk of surgery. In this paper, a vascular interventional robot that can collaboratively deliver multiple interventional instruments has been developed to assist doctors in the operation of complex lesions. Based on the doctor's skills and the delivery principle of interventional instruments, the main and slave manipulators of the robot system are designed. Haptic force feedback is generated through resistance measuring mechanism and active drag system. In addition, a force feedback control strategy based on force-velocity mapping is proposed to realize the continuous change of force and avoid vibration. The proposed robot system was evaluated through a series of experiments. The experimental results show that the system can accurately measure the delivery resistance of interventional instruments, and provide haptic force feedback to doctors. The capability of the system to collaboratively deliver multiple interventional instruments is effective. Therefore, it can be considered that the robot system is feasible and effective.
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6
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Joseph T, VanOosterhout S, Negash A, VanLoo L, Redmond M, Parker JL, McNamara DA, Madder RD. Robotically performed diagnostic coronary angiography. Catheter Cardiovasc Interv 2022; 100:207-213. [PMID: 35621166 DOI: 10.1002/ccd.30250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study was performed to investigate the efficacy and safety of robotic diagnostic coronary angiography. BACKGROUND Robotic percutaneous coronary intervention is associated with marked reductions in physician radiation exposure. Development of robotic diagnostic coronary angiography might similarly impact occupational safety. METHODS Stable patients referred for coronary angiography were prospectively enrolled. After obtaining vascular access, diagnostic catheters were manually advanced over a wire to the ascending aorta. All subsequent catheter movements were performed robotically. The primary endpoint was procedural success, defined as robotic completion of coronary angiography without conversion to a manual procedure and the absence of procedural major adverse cardiovascular events (MACE-cardiac death, cardiac arrest, or stroke) and major angiographic complications (coronary/aortic dissection or embolization). The primary hypothesis was that the observed rate of the primary endpoint, evaluated at the completion of coronary angiography, would meet a pre-specified performance goal of 74.5%. RESULTS Among 46 consecutive patients (age 67 ± 12 years; 69.6% male), diagnostic coronary angiography was completed robotically in all cases without the need for manual conversion and without any MACE or major angiographic complications. Thus, procedural success was 100%, which was significantly higher than the pre-specified performance goal (p < 0.001). Robotic coronary angiography was completed using 2 [2, 3] catheters per case with a median procedural time of 15 [11, 20] minutes. CONCLUSIONS Robotic diagnostic coronary angiography was performed with 100% procedural success and no observed complications. These results support the performance of future studies to further explore robotic coronary angiography.
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Affiliation(s)
- Timothy Joseph
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Stacie VanOosterhout
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Araya Negash
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Lisa VanLoo
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Meaghan Redmond
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Jessica L Parker
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - David A McNamara
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
| | - Ryan D Madder
- Division of Cardiology, Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA
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7
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Jumaa MA, Salahuddin H, Burgess R. The Future of Endovascular Therapy. Neurology 2021; 97:S185-S193. [PMID: 34785617 DOI: 10.1212/wnl.0000000000012807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE REVIEW This article summarizes a broad range of the most recent advances and future directions in stroke diagnostics, endovascular robotics, and neuromodulation. RECENT FINDINGS In the past 5 years, the field of interventional neurology has seen major technological advances for the diagnosis and treatment of cerebrovascular diseases. Several new technologies became available to aid in complex prehospital stroke triage, stroke diagnosis, and interpretation of radiologic findings. Robotics and neuromodulation promise to expand access to established treatments and broaden neuroendovascular indications. SUMMARY Mobile applications offer a solution to simplify prehospital diagnostic and transfer decisions. Several prehospital devices are also under development to improve the accuracy of detection of large vessel occlusion (LVO). Artificial intelligence is now routinely used in early diagnosis of LVO and for detecting salvageability of the affected brain parenchyma. Technological advances have also paved the way to incorporate endovascular robotics and neuromodulation into practice. This may expand the deliverability of established treatments and facilitate the development of cutting-edge treatments for other complex neurologic diseases.
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Affiliation(s)
- Mouhammad A Jumaa
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH.
| | - Hisham Salahuddin
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH
| | - Richard Burgess
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH
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8
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Zhang L, Gu S, Guo S, Tamiya T. A Magnetorheological Fluids-Based Robot-Assisted Catheter/Guidewire Surgery System for Endovascular Catheterization. MICROMACHINES 2021; 12:mi12060640. [PMID: 34070909 PMCID: PMC8226888 DOI: 10.3390/mi12060640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
A teleoperated robotic catheter operating system is a solution to avoid occupational hazards caused by repeated exposure radiation of the surgeon to X-ray during the endovascular procedures. However, inadequate force feedback and collision detection while teleoperating surgical tools elevate the risk of endovascular procedures. Moreover, surgeons cannot control the force of the catheter/guidewire within a proper range, and thus the risk of blood vessel damage will increase. In this paper, a magnetorheological fluid (MR)-based robot-assisted catheter/guidewire surgery system has been developed, which uses the surgeon’s natural manipulation skills acquired through experience and uses haptic cues to generate collision detection to ensure surgical safety. We present tests for the performance evaluation regarding the teleoperation, the force measurement, and the collision detection with haptic cues. Results show that the system can track the desired position of the surgical tool and detect the relevant force event at the catheter. In addition, this method can more readily enable surgeons to distinguish whether the proximal force exceeds or meets the safety threshold of blood vessels.
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Affiliation(s)
- Linshuai Zhang
- School of Control Engineering, Chengdu University of Information Technology, Chengdu 610225, China;
| | - Shuoxin Gu
- School of Control Engineering, Chengdu University of Information Technology, Chengdu 610225, China;
- Correspondence: (S.G.); (S.G.); Tel.: +86-180-8684-8801 (Shuoxin Gu)
| | - Shuxiang Guo
- Faculty of Engineering and Design, Kagawa University, Takamatsu 761-0396, Japan
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, the Ministry of Industry Information Technology, School of Life Science, Beijing Institute of Technology, Beijing 100081, China
- Correspondence: (S.G.); (S.G.); Tel.: +86-180-8684-8801 (Shuoxin Gu)
| | - Takashi Tamiya
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Takamatsu 761-0396, Japan;
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9
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Lemos PA, Franken M, Mariani J, Pitta FG, Oliveira FA, Cunha-Lima G, Caixeta AM, Almeida BO, Garcia RG. Use of robotic assistance to reduce proximity and air-sharing during percutaneous cardiovascular intervention. Future Cardiol 2021; 17:865-873. [PMID: 33834847 DOI: 10.2217/fca-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Traditional percutaneous cardiovascular interventions require close physical proximity between the patients and the healthcare team, posing occupational hazards that range from radiation exposure to interpersonal air contamination. Materials & methods: Prospective single-arm pilot study (n = 10) to investigate robotic-assisted intervention as a strategy to reduce proximity during the procedure. Primary end point: composite of angiographic success, intervention performed with the team positioned >2 meters from the patient for ≥50% procedure duration, and absence of in-hospital death or acute target lesion occlusion. Results: The composite primary end point was achieved in 100% of cases. Conclusion: Robotic-assisted percutaneous intervention provided successful invasive treatment while reducing proximity and shared air space between the care-delivery team and the patient during the procedure. Trial registration number: NCT04379453 (Clinicaltrials.gov).
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Affiliation(s)
- Pedro A Lemos
- Hospital Israelita Albert Einstein, Sao Paulo-SP, Brazil
| | | | - Jose Mariani
- Hospital Israelita Albert Einstein, Sao Paulo-SP, Brazil
| | - Fabio G Pitta
- Hospital Israelita Albert Einstein, Sao Paulo-SP, Brazil
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10
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Lemos PA, Franken M, Mariani J, Pitta FG, Oliveira FAP, Cunha-Lima G, Caixeta AM, Almeida BO, Garcia RG. Robotic-assisted intervention strategy to minimize air exposure during the procedure: a case report of myocardial infarction and COVID-19. Cardiovasc Diagn Ther 2020; 10:1345-1351. [PMID: 33224759 DOI: 10.21037/cdt-20-521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Percutaneous coronary interventions (PCI) is traditionally a manual procedure executed by one or more operators positioned at a close distance from the patient. The ongoing pandemic of coronavirus disease 2019 (COVID-19) has imposed severe restrictions to such an interventional environment. The novel SARS-CoV-2 virus that causes COVID-19 is transmitted mainly through expelled respiratory particles, which are known to travel approximately 3-6 feet away from infected persons. During PCI, that contamination range obligatorily poses the team and the patient to direct air exposure. We herein present a case report with the description of a minimum-contact strategy to reduce interpersonal air exposure during PCI. The approach designed to minimize proximity between the patient and the healthcare team included the performance of robotic-assisted PCI, operated by unscrubbed cardiac interventionalists from a control cockpit located outside the catheterization suite. Also included, was the delineation of the potential zone of respiratory particle spread; a circle measuring 4 meters (13.1 feet) in diameter was traced on the floor of the cath lab with red tape, centered on the patient's mouth and nose. The team was rigorously trained and advised to minimize time spent within the 4-meter perimeter as much as possible during the procedure. Following this strategy, a 60-year-old male with non-ST-elevation myocardial infarction and COVID-19 was treated with successful coronary implantation of two stents in the obtuse marginal branch and one stent in the circumflex artery. The total duration of the procedure was 103 minutes and 22 seconds. During most of the procedure, the 4-meter spread zone was not entered by any personnel. For each individual team member, the proposed strategy was effective in ensuring that they stayed outside of the 4-meter area for the majority of their work time, ranging from 96.9% to 59.7% of their respective participation. This case report illustrates the potential of robotic-assisted percutaneous coronary intervention in reducing physical proximity between the team and the patient during the procedure.
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Affiliation(s)
- Pedro A Lemos
- Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | | | - Jose Mariani
- Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Fabio G Pitta
- Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
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11
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Lopes MACQ, Oliveira GMMD, Ribeiro ALP, Pinto FJ, Rey HCV, Zimerman LI, Rochitte CE, Bacal F, Polanczyk CA, Halperin C, Araújo EC, Mesquita ET, Arruda JA, Rohde LEP, Grinberg M, Moretti M, Caramori PRA, Botelho RV, Brandão AA, Hajjar LA, Santos AF, Colafranceschi AS, Etges APBDS, Marino BCA, Zanotto BS, Nascimento BR, Medeiros CR, Santos DVDV, Cook DMA, Antoniolli E, Souza Filho EMD, Fernandes F, Gandour F, Fernandez F, Souza GEC, Weigert GDS, Castro I, Cade JR, Figueiredo Neto JAD, Fernandes JDL, Hadlich MS, Oliveira MAP, Alkmim MB, Paixão MCD, Prudente ML, Aguiar Netto MAS, Marcolino MS, Oliveira MAD, Simonelli O, Lemos Neto PA, Rosa PRD, Figueira RM, Cury RC, Almeida RC, Lima SRF, Barberato SH, Constancio TI, Rezende WFD. Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019. Arq Bras Cardiol 2020; 113:1006-1056. [PMID: 31800728 PMCID: PMC7020958 DOI: 10.5935/abc.20190205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil.,Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | | | | | | | | | | | - Max Grinberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Miguel Moretti
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - Roberto Vieira Botelho
- Instituto do Coração do Triângulo (ICT), Uberlândia, MG - Brazil.,International Telemedical Systems do Brasil (ITMS), Uberlândia, MG - Brazil
| | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | - Bárbara Campos Abreu Marino
- Hospital Madre Teresa, Belo Horizonte, MG - Brazil.,Pontifícia Universidade Católica de Minas Gerais (PUCMG), Belo Horizonte, MG - Brazil
| | - Bruna Stella Zanotto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil.,Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | - Daniela Matos Arrowsmith Cook
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Copa Star, Rio de Janeiro, RJ - Brazil.,Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
| | | | - Erito Marques de Souza Filho
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brazil.,Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ - Brazil
| | | | - Fabio Gandour
- Universidade de Brasília (UnB), Brasília, DF - Brazil
| | | | | | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Fundação Universitária de Cardiologia, Porto Alegre, RS - Brazil
| | | | | | | | - Marcelo Souza Hadlich
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brazil.,Rede D'Or, Rio de Janeiro, RJ - Brazil.,Unimed-Rio, Rio de Janeiro, RJ - Brazil
| | | | - Maria Beatriz Alkmim
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | | | | | | | - Osvaldo Simonelli
- Conselho Regional de Medicina do Estado de São Paulo, São Paulo, SP - Brazil.,Instituto Paulista de Direito Médico e da Saúde (IPDMS), Ribeirão Preto, SP - Brazil
| | | | - Priscila Raupp da Rosa
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Hospital Sírio Libanês, São Paulo, SP - Brazil
| | | | | | | | | | - Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
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12
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Britz GW, Tomas J, Lumsden A. Feasibility of Robotic-Assisted Neurovascular Interventions: Initial Experience in Flow Model and Porcine Model. Neurosurgery 2019; 86:309-314. [DOI: 10.1093/neuros/nyz064] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/03/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gavin W Britz
- Department of Neurological Surgery and Neurological Institute, Houston Methodist, Houston, Texas
| | | | - Alan Lumsden
- Department of Cardiovascular Surgery, Texas Medical Center, Houston, Texas
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13
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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]
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