Bringing stents precisely to their destination with cardiac catheter robots

Robots in the operating theatre are no longer a rarity in certain medical fields - they support and relieve doctors and sometimes they can make operations more efficient and easier with artificial intelligence (AI). However, they are rarely found in the operating theatre during cardiological interventions.

In the interview with MEDICA-tradefair.com, Prof. Constantin von zur Mühlen explains what advantages a cardiac catheter robot offers for the examiner and the patient, what role AI plays in this and what steps still need to be taken so that such robots can finally take their place in the operating theatre.

Prof. von zur Mühlen, how does the cardiac catheter robot work?

Prof. Constantin von zur Mühlen: We have the classic set-up of a cardiac catheterisation lab, namely a patient couch and an X-ray tube that rotates around the patient and takes images. The robot is an additional arm that can be moved over the examination table. Inside this arm is a sterile cartridge that houses motors, gears and so on. This unit can operate the catheter over which the examination is done, or wires over which stents and balloons are pushed. The operation is not done directly at the cardiac catheter table, but from outside in the control room. There, the examiner sits in front of monitors and can operate these cartridges via joysticks and thus move the wires, the catheters or the balloons back and forth under X-ray control. The examiner can trigger and operate the X-rays via a pedal on his control unit.

In which situations is this robot applicable?

von zur Mühlen: The robot can basically be used for any kind of coronary vessel imaging, namely when there is a planned implantation of a stent. Then the robot arm can be swivelled over the examination table, sterilely covered and a robot-assisted intervention can be carried out directly.

What are the advantages of this robot compared to previous robots?

von zur Mühlen: The topic of robotics in surgical subjects is nothing new for the time being. Up to now, robots have been used mainly in urology, for example in prostate operations with the da Vinci system. Robots in cardiology, on the other hand, are very new. There are first models that are a few years old, but they have nowhere near the functions described. The model we use, which is also suitable for everyday use, is relatively new in its functions and has only been available as such for one or two years. It offers advantages to both patients and examiners.

What are those advantages?

von zur Mühlen: The examiner usually stands next to the radiation source with an X-ray shield. In my case, the protection weighs eight kilos – so I'm standing in the OR all day with eight kilos of weight, and that for decades; it's only a matter of time before you get orthopaedic problems. The robot logically eliminates the need to wear protection because the examiner is in a different room in this case.

In addition, the examiner is no longer standing directly next to the radiation source when using the robot. It is known that brain tumours, for example, can be triggered by years of X-ray radiation affecting the examiner. This risk is considerably reduced by the robot.

For the patients, there is the advantage that one can work very precisely with the robot. With a joystick, stents and wires can be moved forward or backward millimetre by millimetre, placed very precisely and controlled with X-rays – this results in an unbelievably high level of precision that can hardly be achieved with conventional, hand-guided cardiac catheter examinations.

What role does artificial intelligence play in these interventions?

von zur Mühlen: The advantages of artificial intelligence can be incorporated into these interventions in perspective. For example, the robot can remember which joystick movements a doctor triggers in order to successfully bring a wire or stent to its target in certain anatomies. These algorithms can be stored in a cloud and then applied to a comparable anatomy on the other side of the world. And maybe the examiner there does it a little bit better, creating an algorithm that learns for a specific anatomy how to achieve stent implantation fastest, best and safest.

How do you think robotics and its use in everyday clinical practice will develop?

von zur Mühlen: We will see in the next few years. The technology itself works very well and trouble-free, which is an important prerequisite. Of course, it still requires personnel and resources, which is always the case with a new technology at the beginning. We have to see how these two factors can be optimised in the near future so that this robotic examination can be used in the routine on patients in a time-saving and resource-saving way – then the advantages for patients and examiners will come to bear, and then this technology will also offer real added value for everyone involved.