The Development of Robotic Technology in Cardiac and Vascular Interventions.

Ali Pourdjabbar,Ryan R Reeves,Mitul P Patel,Ehtisham Mahmud,Lawrence Ang

doi:10.5041/rmmj.10291

Abstract

Robotic technology has been used in cardiovascular medicine for over a decade, and over that period its use has been expanded to interventional cardiology and percutaneous coronary and peripheral vascular interventions. The safety and feasibility of robotically assisted interventions has been demonstrated in multiple studies ranging from simple to complex coronary lesions, and in the treatment of iliofemoral and infrapopliteal disease. These studies have shown a reduction in operator exposure to harmful ionizing radiation, and the use of robotics has the intuitive benefit of alleviating the occupational hazard of operator orthopedic injuries. In addition to the interventional operator benefits, robotically assisted intervention has the potential to also be beneficial for patients by allowing more accurate lesion length measurement, stent placement, and patient radiation exposure; however, more investigation is required to elucidate these benefits fully.

Highlights

Robotic technology has been used in medicine for several decades, primarily in the fields of surgery[1,2,3] and radiation therapy.[4,5] The use of robotics in cardiovascular medicine began in the early 2000s, and since its introduction robotics has made a tremendous impact in the field
In the recently published BRAIN study, we reported that radiation exposure to invasive cardiologists was significantly higher on the left and center as compared to the right side of the cranium.[18]
This study demonstrates the feasibility of remote robotic percutaneous coronary intervention (PCI), but more importantly highlights one of the major potential benefits offered by this technology

Summary

INTRODUCTION

Robotic technology has been used in medicine for several decades, primarily in the fields of surgery[1,2,3] and radiation therapy.[4,5] The use of robotics in cardiovascular medicine began in the early 2000s, and since its introduction robotics has made a tremendous impact in the field. Radiation safety is a very important aspect of the practice of interventional cardiology, and a number of safety precautions including collimation, use of Eco Dose Fluoroscopy,[19] and operator education[20] have significantly reduced radiation exposure Despite these efforts, the long-term risk of complications associated with chronic radiation exposure can never be completely eliminated. The generation CorPath GRX system that has recently received FDA approval contains active guide control, allowing the operator to control the guide catheter remotely At this point there are no clinical data available with this new-generation system. Since several reports have demonstrated the feasibility of robotic PCI for complex procedures including multi-lesion coronary artery disease, allograft vasculopathy, vein graft PCI, unprotected left main PCI, and ST elevation myocardial infarction (STEMI).[28,29] The Complex Robotically Assisted (CORA) PCI study evaluated the safety and feasibility of robotically assisted PCI and compared clinical outcomes against manual PCI in an all-

Study design

LIMITATIONS AND FUTURE

Findings

CONCLUSIONS