Can robotic navigation simplify challenging revascularization and embolization procedures?
Epublication WebSurg.com, Nov 2014;14(11). URL: http://websurg.com/doi/lt03enchafke001
The Magellan™ robotic system is a peripheral interventional platform that has the potential to provide precise endovascular navigation and therapy delivery using 3D control of robotically steerable catheters and guidewires (1), fast and predictable procedures (1), vessel navigation with less trauma than manual approaches (2), catheter stability during delivery and placement of therapeutic devices, physician protection from radiation exposure and procedural fatigue. It is designed to easily integrate into the hybrid operating room and interventional lab. Our department started the study with the Magellan™ robotic system in November 2012. Up until a hybrid room became available in our institution, the system was set up in a catheterization lab where we were not allowed to perform any cutdowns. Our study included 35 patients, including treated iliac and femoral revascularizations in 19 and 2 cases respectively, internal iliac aneurysms in 4 cases, splenic aneurysms in 3 cases, renal angioplasties in 3 cases, EVAR for contralateral limb catheterization in 2 cases, subclavian artery recanalization in 1 case, and ovarian vein embolization in one case. Regarding iliac revascularization, as for others (3), we found that the robotic system was valuable for long recanalizations of either the common or external iliac arteries, and for multiple stenting of the aorto-iliac tree (up to 4 stents in the same patient for reconstructions of both iliac bifurcations) with one femoral access. Regarding iliac recanalization, the system allows to navigate inside the internal iliac artery aneurysmal sac, to perform embolizations of multiple branches, and also to close the proximal iliac neck of the internal iliac artery above an aneurysm, thereby avoiding coverage with an iliac covering stent. In one case, we performed a distal gonadal vein embolization one day after renal vein transposition performed laparoscopically using the Da Vinci™ robot (4). To conclude, our initial experience with challenging revascularization and embolization procedures demonstrated that robotic technology is both effective and safe in the iliac arterial tree. Although robotics provides superior maneuverability as compared to current techniques, the endovascular experience is crucial to take full benefit of extra capabilities. References: 1. Bismuth J, Stankovic M, Gerzak B, Lumsden AM. The role of flexible robotics in overcoming navigation challenges in the iliofemoral arteries: a first in man study. 69th SVS Annual Meeting, June 2011. Chicago, USA. 2. Bismuth J, Kashef E, Cheshire N, Lumsden A. Feasibility and safety of remote endovascular catheter navigation in a porcine model. J Endovasc Ther 2011;18:243-9. 3. Bismuth J, Duran C, Stankovic M, Gersak B, Lumsden AB. A first-in-man study of the role of flexible robotics in overcoming navigation challenges in the iliofemoral arteries. J Vasc Surg 2013;57:14S-9S. 4. Thaveau F, Nicolini P, Lucereau B, Georg Y, Lejay A, Chakfé N. Associated Da Vinci and Magellan robotic systems for successful treatment of Nutcracker syndrome. J Laparoendos Adv Surg Tech, in correction.