Joystick-powered robot could help surgeons treat strokes remotely

MIT engineers have developed a telerobotic system that helps surgeons quickly and remotely treat patients who have experienced a stroke or aneurysm. With a modified joystick, surgeons in one hospital can control a robotic arm in another location to safely operate the patient during a critical window of time that could save the patient’s life and their brain. to preserve the work.

The robotic system, whose movement is controlled via magnets, is designed to assist remotely in endovascular intervention – an emergency procedure to treat strokes caused by blood clots . Such interventions usually require a surgeon to manually guide a thin wire up to the lump, where it can physically remove the blockage or deliver medications to break it up.

Caption: MIT engineers have developed a telerobotic system that helps surgeons remotely treat patients who have experienced a stroke or aneurysm. With a modified joystick, surgeons can control a robotic arm to operate on a patient in another hospital. Illustration by Researchers

One limitation of such procedures is accessibility: neurovascular surgeons are often based at major medical institutions, which are difficult for patients to access in remote areas, especially during the “golden hour” – the critical period after the onset of stroke. , during which treatment should be administered to minimize any damage to the brain.

The MIT team anticipates that its robotic system could be installed in small hospitals and guided remotely by trained surgeons at large medical centers. The system involves a medical-grade robotic arm attached to your wrist with a magnet. With a joystick and live imaging, an operator can adjust the orientation of the magnet and manipulate the arm to guide a soft, thin magnetic coil through arteries and vessels.

The researchers demonstrated the system in a “phantom,” a transparent model with vessels that mimic the complex arteries of the brain. With only an hour of training, neurosurgeons can remotely control a robotic arm to guide a wire through a maze of vessels to reach targeted locations in the model.

“We imagine, instead of moving a patient from a rural area to a big city, they can go to a local hospital where nurses can set up the system. A neurosurgeon at a major medical center can see a patient’s live imaging and use a robot to work through that golden hour. This is our future dream,” says Xuanhe Zhao, a professor of mechanical engineering and civil and environmental engineer at MIT.

Zhao and his team have published their findings science robotics, MIT co-authors include lead authors Yunho Kim, Emily Genevire, and Jehun Cho, Pablo Harker, Robert Regenhart, Justin Vrennik, Adam Dimitri and Aman Patel at Massachusetts General Hospital (MGH), and Marcin Baliki of Philips Research North America.

tilt and turn

Endovascular surgery is a specialized, minimally invasive procedure that involves carefully twisting and guiding a thin medical wire through the body’s arteries and vessels to a target location to avoid damaging vessel walls. The procedure usually requires years of training for a surgeon to master.

Robotic systems are being explored as assistive technologies in endovascular surgery. These systems primarily consist of motor drives that move and retract a coil while it is rotating through the body’s vasculature.

“But to be a robotic twist with the same sophistication [as a surgeon] Challenging,” notes Kim. “Our system is based on a fundamentally different mechanism.”

The team’s new system is in the works from 2019, in which they demonstrated running a magnetically controlled thread through a life-sized silicon model of the brain’s blood vessels. He did this using a handheld magnet at the time, about the size of a soup can, that he manipulated manually.

He has since affixed the magnet to the end of a medical-grade robotic arm that can be steered using a small joystick knob on a mouse. Researchers can tilt the magnet in a direction that the magnetic wire can follow by tilting the joystick. The mouse’s buttons control a set of motorized linear drives, which move and retract the wire to move it back and forth.

The wire is thin and flexible like a conventional neurovascular guidewire, with a soft, magnetically responsive tip that follows and bends in the direction of a magnetic field.

find a way

The team tested the robotic system in MGH’s Catheter Lab – an operating room with standard medical imaging equipment used in endovascular procedures. Researchers set up a robotic arm and a life-size silicon model of blood vessels in the lab. He set up a monitor displaying live video of the model in a joystick and a control panel. An operator watched the video from afar using a joystick to steer the wire through the ships.

The team trained a group of neurosurgeons to use the robotic system. After only an hour of training, each surgeon successfully mastered the design to guide the wire through complex vessels, which are difficult to navigate with a manual guidewire.

The team also used a robotic system to clean up spurious clots in hard-to-reach areas in the model. They pushed the guidewire through the vessels and pointed corners and reached the areas where the researchers imaged the clot. Once they guided the wire up to the clot, surgeons proceeded with standard endovascular methods to thread a microcatheter along the wire to the site of the clot. He withdrew the wire, releasing the catheter, which he successfully implanted to remove the clot.

“The primary purpose of a magnetic guidewire is to get to the target location quickly and safely. Standard devices such as microcatheters can be used to deliver therapeutics,” says Kim. “Our system is like a guide.”

He hopes the teleoperated system could help more patients receive time-critical treatment. He also sees benefits for surgeons, who typically perform such vascular procedures in the same room as the patient when exposed to radiation from X-ray imaging.

“Neurosurgeons can operate the robot in another room or even in another city without repeated exposure to X-rays,” says Zhao. “We are really 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.”

Written by Jennifer Chuo

Source: Massachusetts Institute of Technology

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