214855Swedish Neuroscience Institute, Seattle, WA, USA.
National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
Interv Neuroradiol. 2023 Apr;29(2):201-210. doi: 10.1177/15910199221082475. Epub 2022 Mar 16.
Robotics could expand treatment of rapidly progressive pathologies such as acute ischemic stroke, with the potential to provide populations in need prompt access to neuro-endovascular procedures.
Robotically-assisted (RA) neuro-endovascular procedures (RANPs) performed at our institution were retrospectively examined (RA-group, RG). A control group of manual neuro-endovascular procedures was selected (manual group, MG). Total operating room (OR) time, procedural time, contrast media use, fluoroscopy time, conversion from RA to manual control, procedural success, and complication rates were compared. A learning curve was identified.
Forty-one (41) RANPs were analyzed. Ages ranged from 20-82 y.o. Indications included diagnostic cerebral angiography (37), extracranial carotid artery stenting (3), and transverse sinus stent (1). Total OR time was longer in RG (median 86 vs. 71 min, p < 0.01). Procedural time (median 56 vs. 45 min, p = 0.12), fluoroscopy time (median 12 vs. 12 min, p = 0.69) and contrast media usage (82 vs. 92 ml, p = 0.54) were not significantly different. Patient radiation exposure was similar, considering similar fluoroscopy times. Radiation exposure and lead apron use were virtually absent for the main surgeon in RG. Procedural success was 83% and conversion from RA to manual control was 17% in RG. No treatment-related complications occurred. A learning curve showed that, after the fifth procedure, procedural times reduced and stabilized.
This series may contribute to further demonstrating the safety and feasibility of RANPs. RANPs can potentially reduce radiation exposure and physical burden for health personnel, expand acute cerebrovascular treatment to underserved areas, and enhance telementoring. Prospective studies are necessary for results to be generalized.
机器人技术可以扩大对迅速发展的疾病（如急性缺血性中风）的治疗范围，有可能为有需要的人群提供及时进行神经血管介入治疗的机会。
对我院进行的机器人辅助神经血管介入治疗（RA-NP）进行回顾性检查（RA 组，RG）。选择手动神经血管介入治疗（手动组，MG）作为对照组。比较总手术室（OR）时间、手术时间、对比剂使用、透视时间、从 RA 转为手动控制、手术成功率和并发症发生率。确定学习曲线。
共分析了 41 例 RA-NP。年龄范围为 20-82 岁。适应证包括诊断性脑血管造影（37 例）、颅外颈动脉支架置入术（3 例）和横窦支架置入术（1 例）。RG 的总 OR 时间较长（中位数 86 分钟比 71 分钟，p<0.01）。手术时间（中位数 56 分钟比 45 分钟，p=0.12）、透视时间（中位数 12 分钟比 12 分钟，p=0.69）和对比剂用量（82 毫升比 92 毫升，p=0.54）无显著差异。考虑到相似的透视时间，患者的辐射暴露相似。RG 中主要外科医生的辐射暴露和铅围裙使用几乎为零。RG 的手术成功率为 83%，从 RA 转为手动控制的比例为 17%。无治疗相关并发症。学习曲线表明，第五次手术后，手术时间减少并稳定。
本系列研究可能有助于进一步证明 RA-NP 的安全性和可行性。RA-NP 可能会降低辐射暴露和医务人员的身体负担，将急性脑血管病的治疗扩展到服务不足的地区，并增强远程指导。需要前瞻性研究来推广结果。
