Joystick-operated robot intervening in stroke treatment remotely − fiction or promise of the future?

Minimally Invasive Procedures in Stroke Treatment

The development of endovascular catheterization techniques has improved mortality, morbidity, and functional outcomes in patients with stroke. The method involves the minimally invasive removal of a thrombus or the treatment of a brain aneurysm through catheterization. The disadvantage of this method is the time-intensive training required for the operator and its general availability − catheterization labs are usually located in larger healthcare facilities.

For patients living in remote areas, it is challenging to ensure early access to catheterization, which should be performed within a few hours of symptom onset. However, in the future, this problem could be solved by the telerobotic system developed by the MIT team, which has been successfully tested on experimental models.

The Next Step in the Evolution of Robotics

The telerobotic system is the next step in the evolution of robot-assisted endovascular surgery. Previously tested systems mainly include motor drives that allow the movement of guide wires within the vascular system and are more suitable for larger vessels than the intricate and fragile system of brain arteries. The robot developed by the MIT team is capable of taking full control of the catheterization method directly at the patient's bedside.

The biggest challenge for the scientists was to create a robotic arm capable of precise and complex movements, allowing the guide wire to be navigated to its destination without the personal assistance of a doctor. The system consists of a robotic arm with a magnet on the hand about the size of a soup can, to which a thin magnetic guide wire with a soft tip is attached. This wire can be bent into the desired direction using a magnetic field. The system is remotely controlled using a special mouse with a joystick, and the operator monitors the entire procedure on a screen.

Although mastering endovascular catheterization requires several years of training, experienced neurosurgeons managed to guide the magnetic guide wire to areas that are difficult to reach using classic catheterization after just one hour of training. The training was conducted on life-sized silicone models of the brain's vascular system, and even included the removal of a platelet thrombus. Once the wire is guided to the target area, the procedure does not differ significantly from classic catheterization − a microcatheter is inserted over the guide wire to remove the thrombus.

Scientists see several advantages in the new method. The first is the ability to perform the procedure over a considerable distance, for example, in areas with difficult access to catheterization care. Smaller regional hospitals would have a catheterization lab with a telerobotic system ready for such cases, which would be remotely operated by an experienced specialist. Another advantage is that operators will not be exposed to radiation as they have been so far, whether they are operating from another room or from a completely different city.

Conclusion

The telerobotic system could become an important assistant in endovascular catheterizations in the future, particularly in areas with limited specialized healthcare. In in vivo environments, the system has so far been tested on the brachial artery of a pig model, and further clinical studies will be needed to verify the method's effectiveness and safety.

(holi)

Sources:
1. Massachusetts Institute of Technology. Joystick-operated robot could help surgeons treat stroke remotely: system could provide teleoperated endovascular treatment to patients during the critical time window after a stroke begins. ScienceDaily, 2022 Apr 13. Available at: www.sciencedaily.com/releases/2022/04/220413141617.htm
2. Kim Y., Genevriere E., Harker P. et al. Telerobotic neurovascular interventions with magnetic manipulation. Sci Robot 2022; 7 (65): eabg9907, doi: 10.1126/scirobotics.abg9907.