Abstract
Remote robotic-assisted endovascular interventions require real-time control of the robotic system to conduct precise device navigation. The delay (latency) between the input command and the catheter response can be affected by factors such as network speed and distance. This study evaluated the effect of network latency on robotic-assisted endovascular navigation in three vascular beds using in-vivo experimental model. Three operators performed femoral, carotid, and coronary endovascular robotic navigation blinded from the hybrid room with the prototype remote-enabled CorPath GRX system in a porcine model. Navigation was performed to different targets with randomly assigned network latencies from 0 to 1000 ms. Outcome measurements included navigation success, navigation time, perceived lag (1 = imperceptible, 5 = too long), and procedural impact scored by the operators (1 = no impact, 5 = unacceptable). Robotic-assisted remote endovascular navigation was successful in all 65 cases (9 femoral, 38 external carotid, 18 coronary). Guidewire times were not significantly different across the simulated network latency times. Compared to 0 ms added latency, both the procedural impact and perceived lag scores were significantly higher when the added latency was 400 ms or greater (< 0.01). Remote endovascular intervention was feasible in all studied anatomic regions. Network latency of 400 ms or above is perceptible, although acceptable to operators, which suggests that remote robotic-assisted femoral, carotid or coronary arterial interventions should be performed with network latency below 400 ms to provide seamless remote device control.
Highlights
Robotic-assisted endovascular interventions have multiple advantages compared to conventional, manually performed interventions
This preclinical study aims to evaluate the effect of network latency on robotic-assisted endovascular navigation in coronary, lower extremity and extracranial arteries using an in vivo experimental model
There was a significant trend for higher procedural impact and perceived latency scores across the three vascular beds with the increasing latencies (p = 0.006 and p = 0.002, respectively) (Fig. 2)
Summary
Robotic-assisted endovascular interventions have multiple advantages compared to conventional, manually performed interventions. They play a significant role in reducing occupational hazards for the operator, such as radiation exposure and orthopedic complications due to heavy lead aprons [1, 2]. With the use of telecommunication, robotic-assisted interventions can be performed from great geographical distances. This method could increase access to care for patients with limited access to appropriate health services, due to geographic barriers, or could allow remote proctoring for certain procedures. The effect of network latency during coronary artery navigation and PCI has been demonstrated, but no data is available on its effect, when robotically navigating in the peripheral arterial system. This preclinical study aims to evaluate the effect of network latency on robotic-assisted endovascular navigation in coronary, lower extremity and extracranial arteries using an in vivo experimental model
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