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The majority of cases the CorPath GRX Neurovascular Robotic System (Siemens Healthineers) has been deployed in to date are cerebral aneurysm treatments— primarily neurovascular coiling and stenting procedures, as per the indications currently approved in Europe. Siemens Healthineers is now working towards expanding into additional markets and, according to Raymond Turner IV, endovascular neurosurgeon at PRISMA Health and Siemens Healthineers chief medical officer (Neurovascular), the company has high hopes for expanding this technology even further across neurointerventions moving forward.
“One benefit we are seeing with the robot today is its ability to give you millimetre accuracy and precision,” says Turner. “When you are treating aneurysms that might be 3mm or 4mm in size, millimetres matter, and being able to move a device by 1mm at a time, if required, is important. And it is not just that it can be more precise than a human—it is more precise every single time.”
According to Turner, another “huge benefit” offered by robotics is control. In addition to removing the issues of physiological tremor and physician fatigue that must be factored into manual procedures, he notes that—because the operator sits at a console, and is closer to the screen than they would be during a non-robotic procedure—this technology enables ergonomic advantages with increased levels of comfort and visibility as well.
The fact that robotics can reduce radiation exposure for the interventionalist by enabling them to operate from a radiation-shielded location is also a key advantage, he adds. And, in cardiology, reduced radiation exposure has been seen in patients too. “I think all of these advantages of the robot should ultimately increase safety—not only by allowing operators to place devices precisely, therefore optimising the treatment, but also by improving the safety profile for the patient,” Turner notes. “Both of those things should drive better outcomes.”
Importance of imaging
“We are 100% dependent on imaging and image quality as neurosurgeons—we are not looking at the brain with our own eyes,” he continues. “So, we need to be able to trust that what we are seeing on the screens is what is really happening. It is very much like imaging is the surgeon’s eyes and robotics is the surgeon’s hands. Bringing the two together is key.”
Again, Turner alludes to subsequently improved patient outcomes, as this could make manoeuvres more efficient and precise. He adds that imaging has a critical role to play here as well, by linking what the physician sees on the screen to what the robot is doing. “In 2022, image quality is phenomenal— compared to even 10 years ago—and it is only going to get better,” he states.
Having introduced the CorPath GRX System at his centre in an effort to reduce COVID-19 infection risks, before using the device for the first time in February 2022, Kamil Zeleňák— head of the Department of Radiology in Comenius University’s Jessenius Faculty of Medicine (Martin, Slovakia)— is currently among the most experienced surgeons in Europe when it comes to robotic-assisted neurovascular procedures.
“There are several advantages to such a system,” he claims. “Firstly, procedures can be performed from a different room to the patient—which is especially relevant in the COVID era. And, potentially, in the future, procedures can be performed from another hospital, another country or even another continent, with the only real limitation being internet speed.” Here, Zeleňák also corroborates Turner’s view that significant reductions in radiation exposure and a level of precision that is difficult to achieve in manual procedures are among robotics’ other key benefits.
He goes on to note that, initially, his centre used the device for diagnostic cases, before expanding into the treatment of intracranial aneurysms across a range of locations via stenting and stent-assisted coiling procedures. Drawing on the 27 in-human cases he has deployed the robot in thus far, Zeleňák says it can “perfectly simulate” every step of a more traditional, manual procedure and, as such, experienced operators should have little difficulty transitioning to using the robotic system.
Zeleňák also attempts to allay fears physicians may have about not being able to feel devices or materials in their own hands, and being more likely to make a mistake as a result, by reiterating that the system is simple and easy to use. Further, he highlights the robot’s built-in ability to help protect patient safety and stop the procedure if it detects too much force being exerted through the system.
“For any procedure, there is a learning curve, and this has been confirmed by previous publications but, if you know what to do already, my view is that the learning curve with robotics is not very big,” Zeleňák adds, in addition to recommending that initial training via in vitro models is a good way to familiarise oneself with the technology.
What does the future hold?
As the robot was only introduced in his centre relatively recently, Zeleňák notes that it is not currently deployed in every one of his neurovascular cases, but says that—beyond additional costs associated with such a new technology—there are no other major limitations preventing its use in almost every case further down the line. “I am 100% sure that, in the very near future, we will be using it in normal, daily practice,” he adds.
In addition, Zeleňák states that future remote capabilities offer “fascinating” potential, such as the possibility for multiple physicians in different hospitals to collaborate on the same case—if they have a robotic system at their centres. He goes on to cite the fact that, in addition, robotic systems may enable more experienced physicians to operate remotely, meaning their time is used more effectively and leading to additional cost-effectiveness benefits.
Zeleňák also believes that, as with artificial intelligence (AI), physicians may worry that robotic technologies are designed to ‘replace’ them, but asserts that this is not the case. “I am convinced that this is the only way we can manage the healthcare system in the future as the number of cases and procedures increases over time,” he concludes.
According to Turner, other fields are moving in a similar direction right now, with the CorPath GRX System having already been approved for cardiovascular and peripheral vascular cases in both the USA and around the globe—and its continued progress both in and out of neurointervention is near-inevitable. He believes robotics will eventually be capable of performing “the vast majority” of neurovascular procedures, with more urgent cases within the stroke care space on the horizon.
“It is important that we see this through,” Turner says. “It takes time, and there is a maturation process while we build up more evidence, but I do not think this is any different from the maturation process we saw when going from open surgery to endovascular techniques. Now, we are moving into robotics. It will happen in our lifetimes, so it is up to us—the physician community—to really help identify opportunities that will help our patients and drive the technology forwards.”
Turner also urges physicians and hospitals to “get on board now and be an early mover”, rather than “sitting on the side-lines”—citing not only the more immediate benefits regarding precision and radiation exposure, but also long-term considerations over implementing robotics at their centres. “We are very much in the infancy of this, but I think [healthcare systems] need to be realistic about where things are going to go in the next three, five, even 10 years, with robotics. It is about making sure that everything is positioned so that, as the technology advances, you advance with it rather than lagging behind and letting the opportunity to improve patient outcomes slip by.”
DISCLAIMER: CorPath GRX for use in neurovascular interventions is available in select markets. It is not available for sale in the USA. Consult your local sales representative to confirm availability. Future availability in all markets cannot be guaranteed. Remote capabilities are currently under development; it is not for sale. Its future availability cannot be guaranteed.