Among the minimally invasive techniques, endovascular interventional surgery is very successful and among these angiography angioplasty and TAVI (Transcatheter Aortic Valve Implant), replacing traditional surgical interventions, which may require extracorporeal circulation and are less tolerated by the patient .
However, even these minimally invasive procedures involve a non-negligible risk, linked to exposure to ionizing radiation (they can induce tumors) not so much for the patient, who is exposed once and for all benefits, but for the doctor who, operating at the side of the patient and while wearing the specific anti-radiation protections, he is in any case forced to undergo an important dose of rays every day to conduct the procedure.
For this reason, a robot was created by Corindus, which allows the guiding of catheters in coronary procedures allowing both advancement and rotation via mouse and joystick, characterized by a large single-use component, and not very versatile.
The idea of this system was initially to develop a new system whose basic mechanism is able to function both as a catheter penetration and rotation meter, in the control section, which reproduces the traditional operating field, and as a robotic actuator. (RA) of the same movements in the actuation section, giving the possibility of independent movement of guide and catheter, also by varying the ratio between the set movement and the one realized, and introducing a small disposable component, while all the rest of the equipment can be used even thousands of times. However, the RA ended up being used only as an actuator, while the console is managed by two joysticks, as well as by a series of knobs.
In addition to this, the system will also be able, by using several RAs placed on a special trolley, both to allow the guide of the first catheter, and of the relative guide also with a mobile core, by coupling two RAs in series, and to also allow the control of two catheter-guide pairs for angioplasty, placing two in parallel and perhaps one in series for the first catheter. By then changing the disposables, we will also be able to bring the catheter and guide to the aortic valve, and then remove the catheter leaving the guide on which to mount the catheter for the TAVI. Furthermore, thanks to an exclusive feature of the RA trolley, it will also be able to allow the forces that oppose the advancement of the catheters, without using special catheters equipped with a sensor. Finally, we are also studying animated catheters whose configuration can be controlled from the console.
In this way the system will also be able to exceed the performance of Magellan, of Hansen Medical, which is dedicated only to endovascular surgery.
In practice, the system allows all the usual operations and also the non-usual ones, being practically modular in the desired configuration, all using small and not too expensive disposables, naturally one for the RA used. All advances are independently controllable and measured, so the system, for example, is able to directly measure the length of a stenosis, allowing the length of the useful area of a stent to be chosen in advance. It should also be noted that the separation operation between guide and catheter is particularly simple, and that obviously the remote controls of both the injection of contrast medium and the inflation of the balloon for angioplasty will also be provided in subsequent versions.
As for the photos, they show the first RA models, suitable for angioplasty only or for catheters of the usual size, up to 8 French, while we are producing the new “Big Mouth” version for the implantation of catheters for TAVI, but will be uses also for angioplasty, which however differs from previous only in the number of teeth of the internal teeth, while the console is already the final one.
