Telerobotic neurovascular interventions with magnetic manipulation
Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery ha...
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| Published in: | Science robotics Vol. 7; no. 65; p. eabg9907 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
13.04.2022
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| Subjects: | |
| ISSN: | 2470-9476, 2470-9476 |
| Online Access: | Get more information |
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| Abstract | Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored because of technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial systems enable robotic manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications because of the considerably smaller and more tortuous anatomy of cerebral arteries. Here, we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance or retract the guidewire and a microcatheter, and a remote-control console to operate the system under real-time fluoroscopy. We demonstrate our system's capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to physicians and open the possibility of remote procedural services to address challenges in current stroke systems of care. |
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| AbstractList | Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored because of technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial systems enable robotic manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications because of the considerably smaller and more tortuous anatomy of cerebral arteries. Here, we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance or retract the guidewire and a microcatheter, and a remote-control console to operate the system under real-time fluoroscopy. We demonstrate our system's capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to physicians and open the possibility of remote procedural services to address challenges in current stroke systems of care. Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored because of technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial systems enable robotic manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications because of the considerably smaller and more tortuous anatomy of cerebral arteries. Here, we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance or retract the guidewire and a microcatheter, and a remote-control console to operate the system under real-time fluoroscopy. We demonstrate our system's capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to physicians and open the possibility of remote procedural services to address challenges in current stroke systems of care.Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored because of technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial systems enable robotic manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications because of the considerably smaller and more tortuous anatomy of cerebral arteries. Here, we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance or retract the guidewire and a microcatheter, and a remote-control console to operate the system under real-time fluoroscopy. We demonstrate our system's capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to physicians and open the possibility of remote procedural services to address challenges in current stroke systems of care. |
| Author | Kim, Yoonho Choe, Jaehun Vranic, Justin E Regenhardt, Robert W Patel, Aman B Zhao, Xuanhe Harker, Pablo Balicki, Marcin Genevriere, Emily Dmytriw, Adam A |
| Author_xml | – sequence: 1 givenname: Yoonho orcidid: 0000-0003-3677-7738 surname: Kim fullname: Kim, Yoonho organization: Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA – sequence: 2 givenname: Emily surname: Genevriere fullname: Genevriere, Emily organization: Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA – sequence: 3 givenname: Pablo orcidid: 0000-0003-0263-8748 surname: Harker fullname: Harker, Pablo organization: Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA – sequence: 4 givenname: Jaehun orcidid: 0000-0003-3444-4219 surname: Choe fullname: Choe, Jaehun organization: Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA – sequence: 5 givenname: Marcin orcidid: 0000-0003-4340-6222 surname: Balicki fullname: Balicki, Marcin organization: Philips Research North America, Cambridge, MA, USA – sequence: 6 givenname: Robert W orcidid: 0000-0003-2958-3484 surname: Regenhardt fullname: Regenhardt, Robert W organization: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA – sequence: 7 givenname: Justin E orcidid: 0000-0002-6000-6709 surname: Vranic fullname: Vranic, Justin E organization: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA – sequence: 8 givenname: Adam A orcidid: 0000-0003-0131-5699 surname: Dmytriw fullname: Dmytriw, Adam A organization: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA – sequence: 9 givenname: Aman B surname: Patel fullname: Patel, Aman B organization: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA – sequence: 10 givenname: Xuanhe orcidid: 0000-0001-5387-6186 surname: Zhao fullname: Zhao, Xuanhe organization: Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35417201$$D View this record in MEDLINE/PubMed |
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