Robotic telestenting in simulator models

Robotic telestenting in simulator models

Robotic telestenting in simulator models: Some time back I had written about “Robotic PCI – Has It Come of Age?” in BMH Medical Journal [1]. The remarkable feature in the PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention) Study was that radiation exposure to the primary operator was 95.2% less [2]. That was a clinical study involving 164 patients at 9 sites.

Ryan D Madder, Stacie VanOosterhout, Jessica Parker, Kalyna Sconzert, Yao Li, Nicholas Kottenstette, Abigail Madsen, John-Michael Sungur and Per Bergman have successfully performed telestenting in simulator models from Boston to New York (206 miles) and San Francisco (3085 miles) [3]. Telestenting were attempted over both wired and fifth generation (5G) wireless networks. Procedural success were obtained in 20 consecutive target lesions in the regional model (Boston to New York) and 16 consecutive target lesions in the trans continental model (Boston to San Francisco).

Greater latency was noted in transcontinental model compared to regional model over both wired and 5G (p < .001) networks. But perceived latencies were graded as imperceptible in all cases in both models. Mean latency was 121.5 ms on wired network and 162.5 ms on 5G network in the transcontinental models. These were 67.8 ms and 86.6 ms respectively in the regional model.

In a previous report from the same group, the REMOTE-PCI study, had explored the feasibility of telestenting where a physician operator performed stenting on a patient in a separate physical location in another room using robotics and telecommunication [4]. There was real-time audio and video connectivity between the operating physician and laboratory personnel. 20 patients had consented for the procedure in the study. Technical success without conversion to manual operation was achieved in 19 of the 22 lesions. Procedural success was achieved in 19 of the 20 patients, with less than 30% residual stenosis and no death or repeat revascularization prior to hospital discharge. There were no deaths or repeat revascularization prior to hospital discharge in the study.

References

1. Johnson Francis. Robotic PCI – Has It Come of Age? BMH Med. J. 2016;3(3):59-60.
2. Weisz G, Metzger DC, Caputo RP, Delgado JA, Marshall JJ, Vetrovec GW, Reisman M, Waksman R, Granada JF, Novack V, Moses JW, Carrozza JP. Safety and feasibility of robotic percutaneous coronary intervention: PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention) Study. J Am Coll Cardiol. 2013 Apr 16;61(15):1596-600.
3. Madder RD, VanOosterhout S, Parker J, Sconzert K, Li Y, Kottenstette N, Madsen A, Sungur JM, Bergman P. Robotic telestenting performance in transcontinental and regional pre-clinical models. Catheter Cardiovasc Interv. 2021 Feb 15;97(3):E327-E332.
4. Madder RD, VanOosterhout SM, Jacoby ME, Collins JS, Borgman AS, Mulder AN, Elmore MA, Campbell JL, McNamara RF, Wohns DH. Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient: an early exploration into the feasibility of telestenting (the REMOTE-PCI study). EuroIntervention. 2017 Jan 20;12(13):1569-1576.