Remote assisted endovascular / simulation

Introduction:

Over the last decade, there has been a rapid development of minimally invasive interventional techniques surrounding endovascular interventions.

There are numerous advantages to using these techniques including faster recovery of the patient and shorter hospital stays. In this monograph

we focus on various techniques for remote assisted endovascular medical applications and remote assisted endovascular simulation for physician

training. The information herein was derived from the references listed at the end of this paper.

The Problem:

Endovascular procedures come with many challenges including the inability to access hard to reach anatomy and to maintain stability during the

procedure. Second, endovascular procedures also require extensive physician training. Remote assisted endovascular devices for medical

applications and simulation devices for physician training have relieved some of these challenges. With the rapid progression in high speed

computation, endovascular procedures have become somewhat simplified. In addition, the advancement of computer hardware and software in

these devices have made the task of gathering and illustrating image data for procedural training dramatically more user friendly.

Medical Applications:

The most common remote assisted endovascular applications involve magnetic tracking technology. These instruments allow for real-time

position measurements of medical devices such as catheters and needles without sight restrictions. Current catheter tracking is performed using

2D fluoroscopy. This technique does have drawbacks such as overlap and foreshortening. Recently, an alternative to fluoroscopy-based tracking

has been proposed. By means of a magnetic tracking system (MTS) the device’s position and orientation is accumulated and then registered to a

pre-operatively acquired image. This is in contrast to the conventional method of tracking the catheter, needle etc. The drawbacks that traditional

methods contain are eliminated by using non-line-of-sight localization systems, such as the MTS, and measuring the device location in 3D space.

In order to carry out many endovascular interventions, a guide wire often needs to be manipulated with fluoroscopic guidance. This task is

complicated by the fact that only projection images are obtainable and that these instruments are made to be handled by the tail end. The

Hansen Medical Catheter Control System is one piece of equipment that has been developed to ease the process. This device uses computed

catheter technology and fine guide catheter control in 3D to provide predictable movement. In addition, its one of a kind design allows the

physician to easily move their workstation away from radiation exposure. This allows the physician the ability to more easily access the anatomy.

By pairing robotic technology with computed movement, the Hansen Catheter Control System allows physicians to more easily control and

maneuver catheters within the heart to treat disorders.

Stereotaxis is another company that has developed technology for remote assisted endovascular procedural applications. The Niobe System, as

it is called, uses computer controlled magnets that are positioned external to the body. When activated, the magnets create magnetic fields

around the patient. The clinician has the ability to programmatically maneuver the magnetic tipped catheters and guidewires throughout the

endovascular system. A digital fluoroscopy system is used to visualize the devices as they are navigated. Like the Hansen CatheterControl

System, the Niobe System allows the physician to be seated in a control room away from radiation exposure. This system allows for more rapid

and precise routing of devices which allows the physician to focus more on the patient and less on the mechanics of the procedure. It is

currently approved in the U.S. for endovascular mapping and is approved abroad for mapping and ablation.

Physician Training:

Recent literature describes the uses of computer simulation for determining endovascular skill levels in procedures such as carotid artery stenting.

While it is quite possible that this practice will gain approval from the US Food and Drug Administration, many questions have been raised on how

to train physicians in its application and its use in other procedures as well. Various simulators have been developed for this reason. The

Vascular Intervention System Training (VIST) simulator is one such model. The VIST consists of a personal computer attached to a mechanical

device that allows the user many actions such as the insertion and manipulation of wires, stents and various other devices. Tactile feedback as

well as simulated visual images are provided to the user. Research suggests that the VIST and devices like it have an important role in training for

carotid artery stenting.

The SimSuite Education System is perhaps one of the most advanced surgical simulators that exist on today’s market. The overall goal of the

system is to improve clinicians’ skills on minimally invasive interventions. With this device, operators are able to perform clinical scenarios just as

they would in an actual procedure. They have the ability to carry out pre-procedure evaluation and management, simulated intervention, and post-

procedure care and management. The system uses real patient scenarios and images as well as true-to-life vascular anatomies. Clinicians are

able to experience their own tactile sensitivity as in real procedures. With the ability to perform entire procedures from start to finish and repeat

the process, if desired, this system provides advanced clinician training.