A recently devised robotic system aimed at cath-lab interventions reduces the radiation exposure of surgeons by 95% while still allowing precise sub-millimeter measurement and 1 mm advancement accuracy. Physicians who have used the equipment say that by optimizing stent selection and positioning, the CorPath Vascular Robotic System lets them position the right stent in the right place.
The system consists of a bedside unit and an interventional cockpit. Developer Corindus Vascular Robotics says the radiation-shielded cockpit features a control console with simple-to-use controls for the precise positioning of guidewires, balloons and stent catheters.
Using joysticks and touchscreen controls, a surgeon can measure anatomy length to select an appropriate stent. The bedside unit is the “engine” of the system, translating commands into precise movements and manipulations of the coronary stents and guidewires.
Working in a cath lab comes with serious occupational hazards. As percutaneous coronary intervention (PCI) procedures become more complex and longer, radiation exposure and time spent in heavy leaded gear increases. Occupational exposure to low-dose ionizing radiation has been shown to have many health consequences for interventional cardiologists, who receive the highest amounts of radiation of any medical professional. In fact, the safety concerns that plague interventionists include brain tumors, orthopedic injuries and cataracts.
Although there have been significant advances in the devices used during PCI, the procedure itself has remained relatively unchanged until recently.
“Robotic therapy is now developing a new standard of care, transforming how physicians approach their procedures,” said Corindus Vascular president and CEO Mark Toland.
Over a career, an interventionist receives about 1,000 mSv (Sievert is a unit of ionizing radiation) exposure to the head, equivalent to 50,000 chest X-rays. Increased exposure to radiation may cause incidents of cancer, specifically brain tumors. One study of self-reported brain tumors in interventionists showed that 86% of the tumors were left-brain—the side of the head most often exposed to radiation during procedures.
There’s also the risk of orthopedic injuries from wearing the heavy, leaded equipment used to block radiation (interventionists practicing over 21 years suffer a 60% incidence of spine issues) and cataracts, another effect of radiation exposure in interventionists. In a RELID study (Retrospective Evaluation of Lens Injuries and Dose), 50% of interventional cardiologists had posterior subcapsular lens changes (precursors to cataracts) caused by radiation exposure, versus less than 10% in the control group.
Corindus developed the CorPath system to bring robotic assistance to interventional cardiology and create a safer work environment for cath-lab teams. One trial (Percutaneous Robotically-Enhanced Coronary Intervention Study) showed a 95.2% reduction in radiation exposure for the primary operator, 98.8% device success and 97.6% clinical success with no device-related complications. What’s more, the trial saw a 9% reduction in stent use as compared to historical data.
Surgeons using the CorPath system perform procedures seated comfortably, without the heavy lead aprons. Three high-resolution monitors provide a sharp view of the procedure from the interventional cockpit.
Corindus recently worked with Massachusetts General Hospital to launch a robot-assisted coronary intervention program with the hospital’s first CorPath System. Mass. General reports successful adoption of the program in just the first few months.
“We continue to build the depth of clinical research on robotics to highlight its value. The system is cleared for use in radial access procedures and radial access has been shown to have benefits for patients,” said Toland.