Robotic treatment starts with the heart

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Robotic-assisted treatment is on the cusp of achieving its full potential, says J Aaron Grantham, consulting chief medical officer for cardiovascular procedures at Corindus, a Siemens Healthineers Company, himself a practicing interventional cardiologist at Saint Luke’s Mid America Heart Institute, Kansas City, USA. He outlines the applications of robotic technology in cardiovascular healthcare, and considers how it could be the tool of the future for interventional cardiology.

Robotics in healthcare has made significant progress following the first surgical application of a robot in 1985. In the years since, the technology has built continued momentum and driven countless new use-cases supported by benefits for both patients and physicians who use robotic technology. The current global health crisis and increased demand for new technology has accelerated that movement—from hospital disinfection robots to four-legged robots equipped with cameras enabling remote patient consultation. As a result, the abundance of choice may leave providers, hospitals and health systems wondering where to begin.

For those looking to integrate robotic-assisted forms of treatment, cardiovascular interventions are perhaps one of the best places to start. As an interventional cardiologist with more than 300 robotic-assisted procedures under my belt, I’ve seen first-hand both the burden of cardiovascular illness, and the ways robotic technology can improve treatment paradigms for patients and providers alike.

The heart of the issue

The prevalence of heart-related illness and mortality made it an obvious starting point for new treatment methods that could also address barriers to care, including geographic location, socioeconomic status and a rapidly shrinking number of skilled specialists. These barriers are especially of concern during a highly emergent medical event such as myocardial infarction.

Second, interventional cardiology takes a tremendous physical toll on practitioners (I have had multiple work-related orthopaedic surgeries, myself), which limits the amount of time we can spend practicing and contributes to shortages in available interventionalists. While cardiology is a tech-forward and evidence-based field, the interventional cardiology subspecialty continues to practice the way it did 40 years ago. Unfortunately, the traditional practice poses significant occupational hazards. Interventional cardiologists experience the highest amount of radiation exposure of any medical professionals. Fluoroscopy can dramatically increase our risk for cancer, cataracts and other radiation-related illnesses. Additionally, we’re prone to orthopaedic injuries involving the spine, hips, knees and ankles due to the weight of personal protective lead aprons we wear during procedures. It’s no wonder that cardiologists experience unusually high levels of burnout.

How robots can help

Robotic-assisted treatment has created a new era for interventional cardiology procedures allowing lab teams the opportunity to provide a high level of patient care while reducing the risks of working in the lab. Robotic precision allows physicians to move interventional devices at extremely small increments and track movements as small as one tenth of a millimeter. That level of precision is unattainable with the human hand alone and helps to ensure that devices are placed correctly for optimal patient outcomes. Robotic assistance can also help reduce the physical toll interventional cardiologists face by reducing exposure to radiation by upwards of 95%.

Incorporating advanced capabilities, such as automation, with existing robotic technology can bolster its impact and potentially make procedures faster and more consistent. For example, automating a “Rotate-on-Retract” movement allows physicians to retract the wire and simultaneously rotate it toward the desired location in one motion – instead of the manual method of pulling back, rotating and going into the desired branch.

As robotic capabilities continue to advance in the cardiovascular space, practitioners in other specialties can draw from lessons learned in this space and apply them to their own field. In cardiology, we have seen the power of robotics as a cornerstone technology and its ability to combine with AI and machine learning, which could impact all fields of medicine.

Neuro is Next

Building upon the strong foundation laid by robotic-assisted cardiovascular intervention, application in the neurovascular space represents the next phase. Stroke is the fifth leading cause of death in the UDA, and for those who survive, a leading cause of long-term disability. A majority of strokes (87%) are ischaemic, blocking all blood flow to the brain, so access to timely care is crucial in preventing death and minimizing the long-term effects. Unfortunately, roughly half of all Americans live more than an hour away from a specialised care facility that can treat stroke and many states don’t have a single comprehensive stroke centre. As a result, patients are dying or living with serious long-term health effects because they did not have access to the appropriate care.

In these scenarios, robotic-assisted treatment that leverages remote capabilities may significantly reduce mortality and long-term disability rates around the world through the delivery of timely, high-quality care from skilled specialists. This is especially important for time-sensitive conditions like stroke. By performing interventions on those patients remotely, ‘telerobotic’ treatment may enhance quality of life and remove tremendous amounts of unnecessary costs for patients and payers in the healthcare system. Neurovascular applications of robotic technology could compensate for low numbers of specialty doctors and limited availability of comprehensive stroke centres throughout the USA, expanding access to care for patients to receive life-saving treatment from a doctor who is outside of their physical reach.

Looking Ahead

Robotic-assisted treatment is on the cusp of achieving its full potential, and with the help of forward-thinking physicians who seek to get involved, we can unlock the full value of this technology. By starting with the heart, robotic-assisted treatment for emergent conditions like myocardial infarction can improve access to timely treatment and significantly improve safety and outcomes for physicians and patients. Additionally, incorporating new capabilities, such as automation and remote treatment, can amplify the reach of a very limited group of specialised physicians to improve the standard of care and treat patients anywhere in the world. The next generation of robotic technology could further improve operator performance, enable more complex procedures, improve patient and operator safety, and expand access to important treatment.

J Aaron Grantham is the consulting chief medical officer for cardiovascular procedures at Corindus, a Siemens Healthineers Company. He is a practicing interventional cardiologist with Saint Luke’s Mid America Heart Institute, Kansas City, USA.


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