Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
Corindus, A Siemens Healthineers Company, Waltham, Massachusetts.
Catheter Cardiovasc Interv. 2021 Feb 15;97(3):E327-E332. doi: 10.1002/ccd.29115. Epub 2020 Jun 25.
This study was conducted to evaluate the association of geographic distance with robotic telestenting performance by comparing performance measures in transcontinental and regional pre-clinical models of telestenting.
Robotic telestenting, in which percutaneous coronary intervention (PCI) is performed on a remotely located patient, might improve PCI access, but has not been attempted over vast distances likely required to reach many underserved regions.
Telestenting performance was compared in regional (Boston to New York [206 miles]) and transcontinental (Boston to San Francisco [3,085 miles]) ex vivo models of telestenting, wherein a physician in Boston attempted robotic PCI on endovascular simulators in New York and San Francisco, respectively. PCI was attempted over both wired and fifth generation (5G)-wireless networks. Outcome measures included procedural success, procedural time, and perceived latency.
Procedural success was achieved in 20 consecutive target lesions in the regional model and in 16 consecutive target lesions in the transcontinental model. The transcontinental model had a greater latency than the regional model over both wired (121.5 ± 2.4 ms vs. 67.8 ± 0.9 ms; p < .001) and 5G-wireless networks (162.5 ± 1.1 ms vs. 86.6 ± 0.6 ms; p < .001), but perceived latencies were graded "imperceptible" in all cases in both models. Transcontinental and regional models did not have significantly different procedural times over wired (4.1 ± 1.9 min vs. 9.0 ± 7.1 min; p = .051) or 5G-wireless (3.0 ± 0.6 vs. 6.3 ± 1.2; p = .36) networks.
Transcontinental robotic manipulation of coronary devices is now possible and was not associated with adverse performance compared to robotic telestenting conducted regionally.
本研究旨在通过比较远程遥控血管成形术的大陆间和区域性临床前模型中的性能指标，评估地理距离与机器人远程遥控操作之间的关联。
远程遥控血管成形术是指对远程患者进行经皮冠状动脉介入治疗（PCI），可能会改善 PCI 通道，但由于可能需要跨越广阔的距离才能到达许多服务不足的地区，因此尚未尝试过这种技术。
在远程遥控血管成形术的区域性（波士顿到纽约[206 英里]）和大陆间（波士顿到旧金山[3085 英里]）的体外模型中比较了遥控操作性能，其中波士顿的医生分别在纽约和旧金山的血管内模拟器上尝试机器人 PCI。在有线和第五代（5G）无线网络上均尝试了 PCI。主要观察指标包括手术成功率、手术时间和感知延迟。
在区域性模型中，20 个连续目标病变中的手术成功率达到了 20 次，在大陆间模型中，16 个连续目标病变中的手术成功率达到了 16 次。在有线网络（121.5±2.4ms 比 67.8±0.9ms；p<0.001）和 5G 无线网络（162.5±1.1ms 比 86.6±0.6ms；p<0.001）中，大陆间模型的延迟时间均大于区域性模型，但在两种模型中，所有情况下的感知延迟均被评为“不可察觉”。在有线网络（4.1±1.9min 比 9.0±7.1min；p=0.051）和 5G 无线网络（3.0±0.6min 比 6.3±1.2min；p=0.36）上，大陆间模型和区域性模型的手术时间没有显著差异。
目前已经可以实现大陆间的冠状动脉设备远程遥控操作，并且与区域性的机器人远程遥控操作相比，其性能没有受到不利影响。
