How Robots Will Re-define the Standards of Endovascular Interventions

The potential impact that remote robotic vascular treatments will have on endovascular interventions was addressed by Lorenzo Patrone, a vascular and interventional radiology consultant with a great interest in robotics who has worked at the West London Vascular and Interventional Centre (London, UK) for 8 years. At LINC, Dr Patrone discussed a new project based on the Sentante, a fully robotic teleoperated system for endovascular interventions that has been created by UAB Inovatyvi Medicina (Kaunas, Lithuania).

The robot can manipulate 3 endovascular instruments that allow an entire procedure to be performed robotically. For flexibility, a variety of dedicated catheters and guidewires are compatible with the robot, regardless of manufacturer, and the endovascular procedure can also be performed from a different room.

Dr Patrone was involved with the good laboratory practice study of the robotic system earlier this year, held in Paris, which tested a set of safety and effectiveness parameters. This data is part of a document submission package to the Food and Drug Administration (FDA) for approval. “It went super well,” said Dr Patrone, who detailed the angioplasty, stenting, and embolization of different vessels that was done as part of the trial. In the summer, the first-in-human trial of the Sentante robot is scheduled to take place in Eastern Europe. “We believe the first-in-human trial will really prove that the Sentante is safe and effective in human beings,” he said.

Importantly, a robotic system has the potential to change the way in which procedures are carried out. “The robot can re-define standards,” noted Dr Patrone. “We have the possibility of staying outside the operating room completely to do procedures and reduce radiation exposure to zero for the operators and nurses.”

In addition, specialist physicians in the future may be able to offer endovascular treatments remotely to patients in hard-to-reach areas, as Dr Patrone detailed: “You can have a nurse help the patient onto the table. From then on, you can operate remotely with robots by using guidewires and catheters which are exchanged by the nurse in the room.”

For Dr Patrone, the biggest potential advantage of a robot under these circumstances is in the treatment of stroke. “Stroke is a pathology which has only a small window of intervention, often just a few hours, so if the patient has symptoms it can still take some time to bring them to the hospital,” he said. “Every minute counts, and sometimes that transit distance is hundreds of kilometres. Often there is no possibility to do a traditional intervention. That is when a robotic-guided procedure may come into its own.”

A unique functionality of the Sentante is its tactile feedback, Dr Patrone highlighted. Most existing robots on the market are operated with joysticks, which makes the operation experience completely different from the real world. “Tactile feedback was something I was very impressed with when I first joined the project,” he said. “This is the only robot which has the possibility to use a catheter and a wire when operating. It is designed to give the same tactile feedback that you’d get every day; you’re just not in the same room.”

It is also possible to increase the preciseness by scaling the movement by a factor of 5. This level of sensitivity and accuracy is of course not feasible without the robot, thus giving the operator the possibility to be incredibly precise in specific tasks, added Dr Patrone.

Another advantage is its size. Some commercial robots are extremely large, noted Dr Patrone, but the Sentante can be fixed to any operating table beside the patient. “It doesn’t really increase the space occupied around the bed because it takes up the space vertically,” he said. “That is what makes it quite easy to incorporate into existing operating suites or hybrid theatres.”

On the other hand, one of the main criticisms of the technology is how long the robot takes to be prepared. A catheter must be physically loaded into the robot, and this takes time— especially evident in simple procedures. “This is one concern which could come up, and actually was a concern when I started,” recalled Dr Patrone. “But I have to say the second generation really is much better than the first one, and engineers have assured me that the Sentante will upload catheters or wires more quickly in future.”

Looking ahead, should the robot receive approval from the FDA and notified European body, and the trial go as well as planned, there will surely be potential for even more improvements. For now, the robot has great promise in truly changing the standards in endovascular care.