Singer Justin, VanOosterhout Stacie, Madder Ryan
Neurosurgery, Spectrum Health, Grand Rapids, Michigan, USA.
Cardiology, Spectrum Health, Grand Rapids, Michigan, USA.
BMJ Neurol Open. 2021 Jun 30;3(1):e000141. doi: 10.1136/bmjno-2021-000141. eCollection 2021.
In acute ischaemic stroke, endovascular thrombectomy (ET) significantly reduces disability compared with thrombolytic therapy, but access to ET is currently limited. Leveraging telerobotic technology to disseminate neurosurgical expertise could increase access to ET. This proof-of-concept evaluation was performed to determine whether remote robotic ET (RRET), wherein an offsite neurosurgeon and an onsite interventional cardiologist collaboratively use telerobotics to perform ET, is technically feasible.
An ex vivo model of RRET was constructed by establishing a network connection between a robotic drive in a simulation laboratory and a robotic control unit 5 miles away. Using onsite assistance from an interventional cardiologist in the simulation laboratory, an offsite neurosurgeon used the robotic controls to attempt RRET on a fluid-filled silicone model of human vasculature containing simulated thrombus material in the left middle cerebral artery (MCA).
From the offsite location 5 miles away, the neurosurgeon used the robotic system to successfully navigate a guidewire from the carotid artery to simulated thrombus in the MCA. Under the direction of the neurosurgeon, the onsite interventional cardiologist then successfully manually advanced an aspiration catheter over the guidewire to the thrombus, removed the guidewire and performed aspiration.
In this proof-of-concept evaluation, the technical feasibility of RRET was demonstrated in an ex vivo model and was collaboratively performed by an offsite neurosurgeon and an onsite interventional cardiologist. This report supports the design of future studies to determine if RRET could be used to increase access to ET for patients with acute ischaemic stroke.
在急性缺血性卒中中，与溶栓治疗相比，血管内血栓切除术（ET）能显著降低致残率，但目前能接受ET治疗的机会有限。利用远程机器人技术传播神经外科专业知识可增加接受ET治疗的机会。进行了这项概念验证评估，以确定远程机器人ET（RRET）在技术上是否可行，即由一名异地神经外科医生和一名现场介入心脏病专家协作使用远程机器人进行ET。
通过在模拟实验室的机器人驱动器与5英里外的机器人控制单元之间建立网络连接，构建了RRET的体外模型。在模拟实验室的介入心脏病专家的现场协助下，一名异地神经外科医生使用机器人控制装置，尝试在一个充满液体的人体血管硅胶模型上进行RRET，该模型的左大脑中动脉（MCA）含有模拟血栓物质。
在5英里外的异地，神经外科医生使用机器人系统成功地将导丝从颈动脉导航至MCA的模拟血栓处。然后，在神经外科医生的指导下，现场介入心脏病专家成功地手动将抽吸导管沿导丝推进至血栓处，移除导丝并进行抽吸。
在这项概念验证评估中，RRET的技术可行性在体外模型中得到了证明，并且由一名异地神经外科医生和一名现场介入心脏病专家协作完成。本报告支持未来研究的设计，以确定RRET是否可用于增加急性缺血性卒中患者接受ET治疗的机会。
