Does the shift away from open surgical vascular procedures towards percutaneous interventions favour a rise in the use of robotics? Gavin Britz (Houston Methodist Hospital, Houston, USA) argues yes, telling delegates at the Society of NeuroInterventional Surgery’s (SNIS) annual meeting (22–25 July, Miami, USA) that the shift has resulted in “faster, safer and more effective treatments”, and has been facilitated by the fact that the underlying disease process “lies within the vascular tree and affords direct access by minimally invasive means”.
Following his presentation of the first study to demonstrate the feasibility of a robotic-assisted platform for intracranial neurovascular interventions, Britz spoke to NeuroNews about the findings of the trial and what the advent of robotic-assisted interventions may mean for the field.
What are the advantages of using robotics for neurovascular procedures?
Firstly, robotic-assisted interventions will decrease the radiation does for the surgeon as the surgeon sits away from the direct radiation. Second, remote surgery will be possible, including remote stroke. This will decrease the work force needs as a well-trained neurointerventionalist surgeon will be able to perform surgery from miles away. This is very important aspect.
Next, remote proctoring is possible with robotics, and will allow a more senior surgeon to remotely help with the cases done by a more junior surgeon. And lastly, automation of dangerous aspects of procedures will make them safer by decreasing human error.
What did you set out to achieve?
Despite advances in robotic-assisted technology for cardiac and peripheral vascular interventions, a robotic-assisted platform for neurovascular intervention is not yet available. The goal of this preclinical study was to evaluate the feasibility of the CorPath GRX robotic-assisted platform (Corindus) for neurovascular interventions.
What were the findings of the study?
The robotic system was tested for its ability to accurately navigate a variety of common neurovascular instruments in an in vitro flow model and in a live, anaesthetised pig, under conditions and following procedures appropriate for clinical intervention. An access catheter was introduced manually at the equivalent of the common carotid artery in both models. Endovascular wires and catheters were navigated through the external and internal carotid artery and posterior cerebral vasculature under robotic assistance using 0.014 in guidewires, 2.4F/1.7F microcatheters, bare-metal stents, and embolic coils.
All procedures in both the flow and pig models, including navigation, wiring, and deployment of the stent, and coils, were performed successfully with no technical complications. There was no evidence of extravasation, dissection, thrombosis, or other vascular injury when angiography was compared before and after the live-animal procedure.
This is the first study to demonstrate that use of a robotic-assisted platform that is feasible for intracranial neurovascular intervention. The robotic system was successful at navigating and deploying the small-gauge instruments specific to neurovascular procedures. Given the potential benefits of robotic-assisted surgery for the patient and the surgeon, further investigation is warranted for this indication, while the technology will continue to evolve and get better.