Regional Vascular Unit, Imperial College London, St Mary's Hospital, London, United Kingdom.
J Vasc Surg. 2010 Apr;51(4):810-9; discussion 819-20. doi: 10.1016/j.jvs.2009.08.101.
Fenestrated stent grafting has allowed the treatment of complex thoraco-abdominal aneurysm disease via a totally endovascular approach, but the procedure can be technically challenging and time consuming. We investigated whether this procedure may be enhanced by remotely steerable robotic endovascular catheters.
A four-vessel fenestrated stent graft partially deployed within a computed tomography (CT)-reconstructed pulsatile thoraco-abdominal aneurysm silicon model was used. Fifteen operators were recruited to participate in the study and divided into three groups, based on their endovascular experience: group A (n = 4, 100-200 endovascular procedures, group B (n = 5, 200-300), and group C (n = 6, >300). All operators were asked to cannulate the renal and visceral vessels under fluoroscopic guidance, using conventional and robotic techniques. Quantitative (catheterization times and wire/catheter tip movements) and qualitative metrics (procedure-specific-rating scale [IC3ST]), which grades operators on catheter use, instrumentation, successful cannulation/catheterization, and overall performance were compared.
Median procedure time for cannulation of all four vessels was reduced using the robotic system (2.87 min, interquartile range [IQR; 2.20-3.90] versus 17.24 min [11.90-19.80]; P < .001) for each individual operator, regardless of the level of endovascular experience. The total number of wire/catheter movements taken to complete the task was also significantly reduced (38, IQR [29-57] versus 454 [283-687]; P < .001). There were significant differences in time and movement for cannulation of each individual vessel in the phantom. Robotic catheter operator radiation exposure was negligible as the robotic workstation is remote and away from the radiation source. Overall performance scores significantly improved using the robotic system, despite minimal operator exposure to this technology (IC3ST score 29/35, IQR [22.8-30.7] versus 19/35 [13-24.3]; P = .002). Each group of operators demonstrated an improvement in performance with robotic cannulation. For group A, median IC3ST score was 28/35, IQR (22-33) versus 15/35 (11-20); P = .04; for group B, 30/35 (27-31) versus 19/35 (18-24); P = .07; and for group C, 28.8/35 (28.5-29) versus 22/35 (16-24); P = .06. For groups B and C, these differences did not reach statistical significance.
Robotic catheterization of target vessels during this procedure is feasible and minimizes radiation exposure for the operator. Steerable robotic catheters with intuitive control may overcome some of the limitations of standard catheter technology, enhance target vessel cannulation, reduce instrumentation, and improve overall performance scores.
开窗支架移植物的使用使得复杂的胸腹主动脉瘤疾病能够通过完全血管内的方法进行治疗，但该手术可能具有技术挑战性且耗时。我们研究了远程可控机器人血管内导管是否可以增强该手术。
使用在 CT 重建的脉动胸腹主动脉瘤硅模型内部分展开的四血管开窗支架移植物。招募了 15 名操作人员参与研究，并根据其血管内经验分为三组：A 组（n=4，100-200 次血管内操作）、B 组（n=5，200-300 次）和 C 组（n=6，>300 次）。所有操作人员均被要求在透视引导下使用常规和机器人技术进行肾和内脏血管的插管。比较了定量（插管时间和导丝/导管尖端运动）和定性指标（特定程序评分量表[IC3ST]），该指标根据导管使用、器械使用、成功插管/导管插入和整体表现对操作人员进行评分。
使用机器人系统可缩短所有 4 个血管插管的中位手术时间（每位操作人员均如此，2.87 分钟[四分位距[IQR]；2.20-3.90] 与 17.24 分钟[11.90-19.80]；P<0.001）。完成任务所需的导丝/导管总运动次数也显著减少（38 次，IQR [29-57] 与 454 次[283-687]；P<0.001）。在模型中，对每个单独的血管进行插管的时间和运动均存在显著差异。由于机器人工作站远离辐射源，因此机器人导管操作人员的辐射暴露可以忽略不计。尽管操作人员对该技术的接触很少，但使用机器人系统可显著提高整体性能评分（IC3ST 评分为 29/35，IQR [22.8-30.7] 与 19/35[13-24.3]；P=0.002）。每组操作人员的插管性能均有所提高。对于 A 组，中位 IC3ST 评分为 28/35，IQR（22-33）与 15/35（11-20）；P=0.04；对于 B 组，30/35（27-31）与 19/35（18-24）；P=0.07；对于 C 组，28.8/35（28.5-29）与 22/35（16-24）；P=0.06。对于 B 组和 C 组，这些差异未达到统计学意义。
在该手术中，对目标血管进行机器人插管是可行的，可最大程度减少操作人员的辐射暴露。具有直观控制功能的可操纵机器人导管可能克服标准导管技术的某些局限性，增强目标血管插管，减少器械使用，并提高整体性能评分。
