By Christopher Zinsmeister, MS2, Wake Forest University School of Medicine
It is only natural for a field predicated on technology to grow, evolve, and improve itself with new advancements. Robotic-assisted surgery is already common place in multiple surgical fields, and it seems interventional radiology will not be exempt from this trend. Catheter-robotics holds much promise in providing a safer operative environment and better outcomes for both the IR team and patients alike.
The concept is simple: a robotic catheter is remotely manipulated by the physician in a separate workstation, away from the radiation source. Radiation exposure is a well-established occupational health risk for interventional physicians1. The health risk is twofold: 1) exposure to harmful radiation and 2) potentially deleterious orthopedic complications from the burdensome personal protective equipment donned by the interventional team1. While there are ongoing improvements to mitigate the above risks, catheter-robotics enables the physician to operate remotely in a radiation-free environment and is thus a logical and effective solution to avoid the aforementioned occupational health risks entirely.
In addition to providing a safer operative environment, robotic catheters will also benefit the IR physician by enhancing the dexterity and maneuverability of the catheter itself. In a robot-assisted fenestrated endovascular aneurysm repair, the interventional team described the robotic technology as having better control and stability with active maneuverability at the catheter tip, which enhanced their ability to place therapeutic devices. The robotic catheter assisted and completed procedures efficiently and significantly faster than what is possible with manual cannulation2. In another case report of a uterine artery embolization performed with a robotic catheter, the authors commented on the augmented navigational capabilities and enhanced stability provided by the device3. Other studies evaluating catheter tracking data reported significant decreases in vessel wall contacts as well as elimination of unnecessary catheter movements during catheterization of aortic arch and carotid vessels4.
Further clinical studies evaluating robotic catheters are required to ensure the feasibility, safety, and efficacy of such devices as well as to characterize its wider applications. The technology is still in early stages of development, but appears to have much potential. Wide-scale implementation is contingent upon device improvements and affordability. The benefits of the device are clear, however. Negligible radiation exposure as well as enhanced dexterity, maneuverability, and decreased operation times will undoubtedly benefit both the IR physician and patient.
1. Klein, L. W. et al. Occupational Health Hazards in the Interventional Laboratory: Time for a Safer Environment. Journal of Vascular and Interventional Radiology 20, S278–S283 (2009). (good paper to cite)
2. Riga, C. V., Bicknell, C. D., Rolls, A., Cheshire, N. J. & Hamady, M. S. Robot-assisted Fenestrated Endovascular Aneurysm Repair (FEVAR) Using the Magellan System. Journal of Vascular and Interventional Radiology 24, 191–196 (2013).
3. Rolls, A. E. et al. Robot-Assisted Uterine Artery Embolization: A First-in-Woman Safety Evaluation of the Magellan System. Journal of Vascular and Interventional Radiology 25, 1841–1848 (2014).
4. Katzen, B. T. Robotic Catheterization: The Importance of Evaluation by Interventional Radiologists. Journal of Vascular and Interventional Radiology 25, 1848–1849 (2014).