Initial Experience in a Pig Model of Robotic-Assisted Intracranial Arteriovenous Malformation (AVM) Embolization

Abstract BACKGROUND Robotic assistance for coronary and peripheral vascular pathologies is steadily gaining popularity. However, it has yet to be applied to neurovascular intervention. OBJECTIVE To establish the feasibility of the CorPath® GRX robotic-assisted platform (Corindus Inc, Waltham, Massachusetts) for intracranial arteriovenous malformation (AVM) embolization. METHODS This robotic system was used to embolize intracranial AVMs (n = 4) in 2 anesthetized pigs, under controlled conditions appropriate for clinical intervention. Initially, a catheter was manually introduced into the common carotid artery (CCA). Then, the robotic system was used to advance the catheter into the ascending pharyngeal artery (APA) towards the rete mirabilis, which was used as a model for an AVM, using 0.014 in guidewires and 2.4F/1.7F microcatheters. After doing a pre-embolization APA run, which demonstrated good visualization of the rete, dimethyl sulfoxide (DMSO) was instilled into the microcatheter. A negative roadmap was then done, and Onyx was used to embolize the rete. RESULTS All 4 AVMs were completely obliterated with no complications, including no contrast extravasation, dissection, thrombosis, or other vascular injury. CONCLUSION This study is the first to demonstrate the feasibility of a robotic-assisted platform for intracranial AVM embolization.

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Neuroendovascular-specific engineering modifications to the CorPath GRX Robotic System

Journal of Neurosurgery ◽

10.3171/2019.9.jns192113 ◽

2020 ◽

Vol 133 (6) ◽

pp. 1830-1836 ◽

Cited By ~ 4

Author(s):

Gavin W. Britz ◽

Sandip S. Panesar ◽

Peter Falb ◽

Johnny Tomas ◽

Virendra Desai ◽

...

Keyword(s):

Carotid Artery ◽

Robotic System ◽

Robotic Assistance ◽

Peripheral Vascular ◽

Forward Motion ◽

Active Device ◽

Vascular Intervention ◽

Peripheral Vascular Intervention ◽

The Common ◽

The Mean

OBJECTIVEThe aim of this study was to evaluate new, neuroendovascular-specific engineering and software modifications to the CorPath GRX Robotic System for their ability to support safer and more effective cranial neurovascular interventions in a preclinical model.METHODSActive device fixation (ADF) control software, permitting automated manipulation of the guidewire relative to the microcatheter, and a modified drive cassette suitable for neuroendovascular instruments were the respective software and hardware modifications to the current CorPath GRX robot, which was cleared by the FDA for percutaneous coronary and peripheral vascular intervention. The authors then trialed the modified system in a live porcine model with simulated neuroendovascular pathology. Femoral access through the aortic arch to the common carotid artery was accomplished manually (without robotic assistance), and the remaining endovascular procedures were performed with robotic assistance. The system was tested for the enhanced ability to navigate and manipulate neurovascular-specific guidewires and microcatheters. The authors specifically evaluated the movement of the wire forward and backward during the advancement of the microcatheter.RESULTSNavigation of the rete mirabile and an induced aneurysm within the common carotid artery were successful. The active device fixation feature enabled independent advancement and retraction of the guidewire and working device relative to the microcatheter. When ADF was inactive, the mean forward motion of the guidewire was 5 mm and backward motion was 0 mm. When ADF was active, the mean forward motion of the guidewire was 0 mm and backward motion was 1.5 mm. The modifications made to the robotic cassette enabled the system to successfully manipulate the microcatheter and guidewire safely and in a manner more suited to neuroendovascular procedures than before. There were no occurrences of dissection, extravasation, or thrombosis.CONCLUSIONSThe robotic system was originally designed to navigate and manipulate devices for cardiac and peripheral vascular intervention. The current modifications described here improved its utility for the more delicate and tortuous neurovascular environment. This will set the stage for the development of a neurovascular-specific robot.

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Faculty Opinions recommendation of Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.722510332.793514376 ◽

2016 ◽

Author(s):

Armando Lorenzo

Keyword(s):

Initial Experience ◽

University Of Chicago ◽

Robotic Assisted ◽

The University

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Operation under hypothermia in a pregnant woman with an intracranial arteriovenous malformation

Canadian Anaesthetists Society journal / Journal de la Société canadienne des anesthésistes ◽

10.1007/bf03005048 ◽

1972 ◽

Vol 19 (2) ◽

pp. 184-191 ◽

Cited By ~ 7

Author(s):

Akitomo Matsuki ◽

Tsutomu Oyama

Keyword(s):

Pregnant Woman ◽

Arteriovenous Malformation ◽

Intracranial Arteriovenous Malformation

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Ethylene vinyl alcohol copolymer to treat an intracranial arteriovenous malformation in a dog

Journal of Veterinary Internal Medicine ◽

10.1111/jvim.16120 ◽

2021 ◽

Author(s):

William T. N. Culp ◽

Ann Gratzek ◽

Merrianne Burtch ◽

Brian C. Dahlin ◽

Paul R. Dong ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Vinyl Alcohol ◽

Intracranial Arteriovenous Malformation ◽

Ethylene Vinyl Alcohol ◽

Ethylene Vinyl Alcohol Copolymer

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Robotic-Assisted Endoscopic Laminotomy: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa441 ◽

2021 ◽

Author(s):

Yingda Li ◽

Michael Y Wang

Keyword(s):

Spine Surgery ◽

Human Error ◽

Robotic Assistance ◽

The Novel ◽

Robotic Assisted ◽

Accuracy And Precision ◽

Surgical Ergonomics ◽

Patient Consent ◽

Potential Synergy ◽

And Robotics

Abstract Endoscopy and robotics represent two emerging technologies within the field of spine surgery, the former an ultra-MIS approach minimizing the perioperative footprint and the latter leveraging accuracy and precision. Herein, we present the novel incorporation of robotic assistance into endoscopic laminotomy, applied to a 27-yr-old female with a large caudally migrated L4-5 disc herniation. Patient consent was obtained. Robotic guidance was deployed in (1) planning of a focussed laminotomy map, pivoting on a single skin entry point; (2) percutaneous targeting of the interlaminar window; and (3) execution of precision drilling, controlled for depth. Through this case, we illustrated the potential synergy between these 2 technologies in achieving precise bony removal tailored to the patient's unique pathoanatomy while simultaneously introducing safety mechanisms against human error and improving surgical ergonomics.1,2 The physicians consented to the publication of their images.

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Development of an autonomous robotic system for beard shaving assistance of disabled people based on an adaptive force tracking impedance control

Proceedings of the Institution of Mechanical Engineers Part C Journal of Mechanical Engineering Science ◽

10.1177/0954406220984821 ◽

2021 ◽

pp. 095440622098482

Author(s):

Oladayo S Ajani ◽

Samy FM Assal

Keyword(s):

Impedance Control ◽

Environmental Parameters ◽

Robotic System ◽

Robotic Systems ◽

Full Potential ◽

Robotic Assistance ◽

Head Pose ◽

Detection And Tracking ◽

Control Scheme ◽

Force Tracking

Recently, people with upper arm disabilities due to neurological disorders, stroke or old age are receiving robotic assistance to perform several activities such as shaving, eating, brushing and drinking. Although the full potential of robotic assistance lies in the use of fully autonomous robotic systems, these systems are limited in design due to the complexities and the associated risks. Hence, rather than the shared controlled or active robotic systems used for such tasks around the head, an adaptive compliance control scheme-based autonomous robotic system for beard shaving assistance is proposed. The system includes an autonomous online face detection and tracking as well as selected geometrical features-based beard region estimation using the Kinect RGB-D camera. Online trajectory planning for achieving the shaving task is enabled; with the capability of online re-planning trajectories in case of unintended head pose movement and occlusion. Based on the dynamics of the UR-10 6-DOF manipulator using ADAMS and MATLAB, an adaptive force tracking impedance controller whose parameters are tuned using Genetic Algorithm (GA) with force/torque constraints is developed. This controller can regulate the contact force under head pose changing and varying shaving region stiffness by adjusting the target stiffness of the controller. Simulation results demonstrate the system capability to achieve beard shaving autonomously with varying environmental parameters that can be extended for achieving other tasks around the head such as feeding, drinking and brushing.

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True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Journal of Personalized Medicine ◽

10.3390/jpm11070662 ◽

2021 ◽

Vol 11 (7) ◽

pp. 662

Author(s):

Kim Huber ◽

Bernhard Christen ◽

Sarah Calliess ◽

Tilman Calliess

Keyword(s):

Soft Tissue ◽

Retrospective Analysis ◽

Patient Specific ◽

Kinematic Alignment ◽

Postoperative Phase ◽

Robotic Assistance ◽

Component Position ◽

Joint Stability ◽

Robotic Assisted ◽

Primary Tkas

Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.

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