MIT engineers have developed a telerobotic system to assist surgeons rapidly and remotely deal with sufferers experiencing a stroke or aneurysm. With a modified joystick, surgeons in a single hospital could management a robotic arm at one other location to securely function on a affected person throughout a vital window of time that might save the affected person’s life and protect their mind perform.
The robotic system, whose motion is managed by magnets, is designed to remotely help in endovascular intervention — a process carried out in emergency conditions to deal with strokes attributable to a blood clot. Such interventions usually require a surgeon to manually information a skinny wire to the clot, the place it might probably bodily clear the blockage or ship medication to interrupt it up.
One limitation of such procedures is accessibility: Neurovascular surgeons are sometimes based mostly at main medical establishments which might be tough to succeed in for sufferers in distant areas, significantly in the course of the “golden hour” — the vital interval after a stroke’s onset, throughout which remedy must be administered to reduce any injury to the mind.
The MIT staff envisions that its robotic system might be put in at smaller hospitals and remotely guided by skilled surgeons at bigger medical facilities. The system features a medical-grade robotic arm with a magnet connected to its wrist. With a joystick and reside imaging, an operator can regulate the magnet’s orientation and manipulate the arm to information a mushy and skinny magnetic wire by arteries and vessels.
The researchers demonstrated the system in a “phantom,” a clear mannequin with vessels replicating advanced arteries of the mind. With simply an hour of coaching, neurosurgeons had been capable of remotely management the robotic’s arm to information a wire by a maze of vessels to succeed in goal areas within the mannequin.
“We think about, as an alternative of transporting a affected person from a rural space to a big metropolis, they may go to an area hospital the place nurses may arrange this method. A neurosurgeon at a serious medical middle may watch reside imaging of the affected person and use the robotic to function in that golden hour. That’s our future dream,” says Xuanhe Zhao, a professor of mechanical engineering and of civil and environmental engineering at MIT.
Zhao and his staff have revealed their findings in the present day in Science Robotics. MIT co-authors embody lead writer Yoonho Kim, Emily Genevriere, and Jaehun Choe, together with Pablo Harker, Robert Regenhardt, Justin Vranic, Adam Dmytriw, and Aman Patel at Massachusetts Common Hospital (MGH), and Marcin Balicki of Philips Analysis North America.
Tilt and twist
Endovascular surgical procedure is a specialised, minimally invasive process that entails rigorously twisting and guiding a skinny medical wire by the physique’s arteries and vessels to a goal location, in a means that avoids damaging vessel partitions. The process sometimes requires years of coaching for a surgeon to grasp.
Robotic techniques are being explored as assistive applied sciences in endovascular surgical procedure. These techniques primarily contain motor drives that advance and retract a wire whereas twisting it by the physique’s vasculature.
“However having a robotic twist with the identical degree of sophistication [as a surgeon] is difficult,” Kim notes. “Our system is predicated on a essentially totally different mechanism.”
The staff’s new system builds on work from 2019, through which they demonstrated steering a magnetically managed thread by a life-sized silicone mannequin of the mind’s blood vessels. They did so on the time utilizing a handheld magnet, in regards to the dimension of a soup can, that they manually manipulated.
They’ve since affixed the magnet to the top of a medical-grade robotic arm, which might be steered utilizing a small joystick knob on a mouse. By tilting the joystick, researchers can tilt the magnet in an orientation {that a} magnetic wire can observe. Buttons on the mouse management a set of motorized linear drives, which advance and retract the wire to make it transfer ahead and again.
The wire is as skinny and versatile as a traditional neurovascular guidewire, with a mushy, magnetically responsive tip that follows and bends within the route of a magnetic area.
Discovering a path
The staff examined the robotic system in MGH’s Catheter Lab — an working room with customary medical imaging gear utilized in endovascular procedures. The researchers put in the robotic arm within the lab, together with a life-sized silicone mannequin of blood vessels. They set the joystick, together with a monitor displaying a reside video of the mannequin, in a management room. From there, an operator watched the video whereas utilizing the joystick to remotely steer the wire by the vessels.
The staff skilled a gaggle of neurosurgeons to make use of the robotic system. After only one hour of coaching, every surgeon was capable of efficiently function the system to information the wire by advanced vessels which might be tough to navigate with a handbook guidewire.
The staff additionally used the robotic system to clear simulated clots in difficult-to-reach areas within the mannequin. They steered the guidewire by vessels, and round sharp corners and turns, to succeed in areas the place the researchers simulated clots. As soon as they guided the wire to the clot, the surgeons proceeded with customary endovascular strategies to string a microcatheter alongside the wire to the positioning of the clot. They retracted the wire, leaving the catheter, which they then utilized to efficiently take away the clot.
“The first goal of the magnetic guidewire is to get to the goal location rapidly and safely, in order that customary gadgets like microcatheters can be utilized to ship therapeutics,” Kim says. “Our system is sort of a pathfinder.”
He hopes that the teleoperated system might help extra sufferers obtain time-critical remedy. He additionally sees advantages for surgeons, who sometimes carry out such vascular procedures in the identical room because the affected person, whereas being uncovered to radiation from X-ray imaging.
“The neurosurgeons can function the robotic in one other room and even in one other metropolis with out repeated publicity to X-rays,” Zhao says. “We’re really excited in regards to the potential impression of this expertise on international well being, provided that stroke is among the main causes of loss of life and long-term incapacity.”
This analysis was supported partly by the Nationwide Science Basis, the Nationwide Institutes of Well being, and Phillips Analysis of North America.
