A new telerobotic system developed by engineers at Massachusetts Institute of Technology (MIT) enables surgeons to remotely treat patients suffering from a stroke or aneurysm. The system utilizes a joystick that the surgeons can use in a hospital to control a robotic arm at another location. This enables them to operate on patients during the critical time window needed to preserve brain function and save lives.
The research was published in Science Robotics.
The robotic system’s movement is controlled through magnets and was designed to remotely assist in endovascular intervention. These interventions traditionally require surgeons to manually guide a thin wire to a blood clot to physically clear the blockage or deliver drugs.
One of the problems with this approach is that neurovascular surgeons are usually based at major medical institutions, which makes it difficult for them to operate in remote areas when needed.
Enabling Remote Operation
According to the MIT team, this robotic system could be installed at smaller hospitals and enable trained surgeons to remotely guide it from larger medical institutions. The system has a medical-grade robotic arm with a magnet attached to its wrist. The joystick and live imaging allows an operator to adjust the magnet’s orientation and manipulate the robot arm to guide a thin magnetic wire through arteries and vessels.
In the testing phase, which involves a transparent model with vessels replicating arteries of the brain, the neurosurgeons could remotely control the robot’s arm to guide the wire to target locations. It only took them one hour of training to achieve this.
Xuanhe Zhao is a professor of mechanical engineering and of civil and environmental engineering at MIT.
“We imagine, instead of transporting a patient from a rural area to a large city, they could go to a local hospital where nurses could set up this system. A neurosurgeon at a major medical center could watch live imaging of the patient and use the robot to operate in that golden hour. That’s our future dream,” Zhao says.
Robotic systems are increasingly being researched as assistive technologies in endovascular surgery.
Yoonho Kim is a lead author of the research.
“But having a robot twist with the same level of sophistication [as a surgeon] is challenging,” Kim says. “Our system is based on a fundamentally different mechanism.”
Testing the System
The robotic system was tested in MGH’s Catheter Lab, which is an operating room used in endovascular procedures. The system was installed along with a life-sized silicone model of blood vessels. The joystick was set with a monitor displaying a live video of the model, which the operator could watch while using the joystick to remotely guide the wire.
The team used the system to also clear simulated clots in difficult-to-reach areas. After guiding the wire to the clot, the surgeons then relied on standard endovascular methods to thread a microcatheter along the wire to the site of the clot. The wire was then retracted.
“The primary purpose of the magnetic guidewire is to get to the target location quickly and safely, so that standard devices like microcatheters can be used to deliver therapeutics,” Kim says. “Our system is like a pathfinder.”
Kim hopes that this new system helps patients receive treatment during those critical time periods. He also believes it can benefit surgeons who perform other vascular procedures while being exposed to radiation from X-ray imaging.
“The neurosurgeons can operate the robot in another room or even in another city without repeated exposure to X-rays,” Zhao says. “We are truly excited about the potential impact of this technology on global health, given that stroke is one of the leading causes of death and long-term disability.”
Other co-authors of the research included Emily Genevriere and Jaehun Choe from MIT, as well as Pablo Harker, Robert Regenhardt, Justin Vranic, Adam Dmytriw, and Amal Patel at Massachusetts General Hospital (MGH). Marcin Balicki from Philips Research North America also participated.