Telerobotic neurovascular interventions with magnetic manipulation.
Telerobotic neurovascular interventions with magnetic manipulation.
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DOI：
10.1126/scirobotics.abg9907
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发表时间：
2022-04-13
期刊：
影响因子：
25
通讯作者：
中科院分区：
文献类型：
--
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机器人技术的进步已被应用于开放手术和微创手术的各个子专业，带来了提高手术精确度和准确性、减少工作量和疲劳等好处。尽管有这些优点，但由于技术挑战，例如可以到达复杂和曲折的大脑血管系统的机器人设备的小型化，机器人在血管内神经外科手术中的应用在很大程度上仍未得到探索。尽管一些商业机器人系统能够精确操纵用于冠状动脉和外周血管介入的常规导丝，但由于脑动脉的解剖结构相当小且更曲折，它们仍然不适合神经血管应用。在这里，我们提出了一种基于磁操纵的远程机器人神经介入平台。我们的系统包括一个磁控导丝，一个机器人手臂与致动磁铁转向导丝，一套电动线性驱动器推进/撤回导丝和微导管，和一个远程控制台操作系统的反馈下，从实时荧光透视。我们证明了我们的系统的能力，既在体外与现实的神经血管幻影代表人体解剖结构和在体内的猪肱动脉与临床前评价加重迂曲度导航狭窄和曲折的途径。我们进一步展示了远程机器人辅助治疗程序，包括弹簧圈栓塞和凝块取出血栓切除术，分别用于治疗脑动脉瘤和缺血性卒中。我们的远程机器人神经介入系统可以更安全，更快地进入难以到达的病变，同时最大限度地减少介入医生的辐射暴露，并打开远程手术服务的可能性，以解决当前中风护理系统的挑战。我们提出了一个远程操作的磁操纵平台，使机器人应用到血管内神经外科治疗中风和动脉瘤。
Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced efforts and fatigue. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored due to technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial robotic systems enable precise manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications due to the considerably smaller and more tortuous anatomy of cerebral arteries. Here we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance/retract the guidewire and a microcatheter, and a remote-control console to operate the system under feedback from real-time fluoroscopy. We demonstrate our system’s capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our telerobotic neurointerventional system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to interventionalists and open the possibility of remote procedural services to address challenges in current stroke systems of care. We present a teleoperated magnetic manipulation platform to enable robotic applications to endovascular neurosurgery for treating stroke and aneurysms.
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影响因子：
4.8
作者：
Bechstein M;Elsheikh S;Wodarg F;Taschner CA;Hanning U;Buhk JH;McDonough R;Goebell E;Fiehler J;Bester M
通讯作者：
Bester M
影响因子：
7.9
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Jeon S;Hoshiar AK;Kim K;Lee S;Kim E;Lee S;Kim JY;Nelson BJ;Cha HJ;Yi BJ;Choi H
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Choi H
影响因子：
2.8
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Goebell, Einar
影响因子：
4.8
作者：
Britz, Gavin W.;Tomas, Johnny;Lumsden, Alan
通讯作者：
Lumsden, Alan
影响因子：
3.7
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Arikan F;Martínez-Valverde T;Sánchez-Guerrero Á;Campos M;Esteves M;Gandara D;Torné R;Castro L;Dalmau A;Tibau J;Sahuquillo J
通讯作者：
Sahuquillo J