With the COVID-19 pandemic creating new barriers to the accessibility of healthcare, the successful completion of Europe’s first remote robotic-assisted percutaneous coronary intervention (PCI) in December 2020 offers a glimpse of the role that long-distance procedures could play in future delivery of coronary angioplasty.
The procedure, carried out by Eric Durand at the Rouen Medical Training Center, Rouen, France and Rémi Sabatier, Caen University Hospital, Caen, France—spanning 75 miles between the two locations—was the first of its kind in Europe completed with the R-One (Robocath) robotic-assistance platform, using an animal model.
During the procedure, constant communication was maintained between Sabatier—who was operating the robot via a control console from Caen University Hospital—and Durand, who oversaw proceedings from the operating room at the Medical Training Center in Rouen. Cardiovascular News spoke to Sabatier following the completion of the procedure, discussing the potential for robotics, controlled remotely, to play a role in the cath lab in future.
What potential do remote robotic PCI procedures offer—how will this shape PCI in the future?
I was very excited to do this first case. The excitement was surpassed by how easy it was to do, as it was very convenient. Of course I had Professor Durand in the medical training centre who managed the animal and the introduction of devices into the robot, but I can do the procedure without any difficulty in quite a short time. It was quite surprising to me, to feel like I was near the animal. The distance was not really present, and this was a new development.
There are still a lot of questions around remote PCI in coronary angioplasty, but the technologic part is done now. It is both possible and convenient, and the question now is about how we organise the remote intervention. There are a lot of challenges, but none of them are insurmountable.
How does the procedure work in practice?
The pig was in the Medical Training Centre in Rouen. Professor Durand inserted a 6-F sheath in the femoral artery and a guiding catheter (Amplatz Left 1) in the left coronary artery manually and connected it to the robot. He also inserted a guidewire in the robot. Then, I was able to advance the guidewire in the circumflex artery using the joystick in Caen through the control console.
When the guidewire was positioned in the distal left circumflex artery, Professor Durand manually inserts the stent on the wire in the robot. The remote control console of the robot allow me to advance the stent in the circumflex from 75 miles away, and to implant it after manual inflation.
How easy is it for any interventional cardiologist to pick up technology and use it?
I think the learning curve is easy to pick up. We run training workshops in Rouen, and we see that interventional cardiologists learn very quickly the positioning of the robot, and performing angioplasty, because it is very intuitive. The joysticks do the same as you would do with your hand.
The precision of the mechanism is also something very impressive.
How great is the need for remote technologies—how common could remote robotics for coronary angiography be in the future?
There are still some gaps to fill, but the need is there. There are a lot of regions in the world and especially the developing countries, where patients are too far from interventional centres and could not have angioplasty in case of acute myocardial infarction or thrombectomy in case of acute stroke.
We need more technical platforms to allow patients to be treated in non-interventional centres, we need to train nurses or doctors to place the introducer into the radial or femoral artery and then to engage the guiding catheter—but maybe in the future robots could do a part of this job.
What are the key questions that still need to be answered?
There is one that is always discussed and that is how do you manage robotic failure or angioplasty complication if nobody in the patient location can do the angioplasty.
Coronary angioplasty is quite a safe procedure, and hopefully the robot will not have a lot of failures, but we have to face this situation because it is important to overcome this barrier. It could be done by training doctors in specific procedures to manage complications, but there is still work to do in this field.