Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient

Selected in EuroIntervention by S. Brugaletta

S. Brugaletta reviews an article from EuroIntervention on an early exploration into the feasibility of telestenting (the REMOTE-PCI study)

References

Authors

Madder RD, VanOosterhout SM, Jacoby ME, Collins JS, Borgman AS, Mulder AN, Elmore MA, Campbell JL, McNamara RF, Wohns DH

Reference

EuroIntervention. 2017 Jan 20;12(13):1569-1576

Published

January 2017

Link

Read the abstract

My Comment

What is known 

Percutaneous coronary intervention (PCI) has traditionally been a manual procedure wherein a physician operator advances, retracts, and torques interventional devices in the coronary arteries by hand while standing adjacent to the patient. A robotic system for performing PCI has recently been introduced, which allows an operator to perform stenting while seated at robotic controls located in the corner of the catheterisation laboratory. To date, all coronary stenting procedures, whether conducted manually or robotically, have been performed by an operating physician located in the same procedure room as the patient.
The present study was designed to assess the feasibility of the following concept: 1) removing the physician operator from the procedure room housing the patient; and 2) having the physician operator perform PCI from behind the closed doors of an isolated separate room using a combination of robotics and telecommunication devices.

Major findings 

  • All manipulations of guidewires, balloons, and stents were performed robotically by a physician operator located in an isolated separate room outside the procedure room housing the patient.
  • Communication between the operating physician and laboratory personnel was via telecommunication devices providing real-time audio and video connectivity.
  • Among 20 patients who consented to participate, technical success, defined as successful advancement and retraction of guidewires, balloons, and stents by the robotic system without conversion to manual operation, was achieved in 19 of 22 lesions (86.4%).
  • Procedural success, defined as <30% residual stenosis upon completion of the procedure in the absence of death or repeat revascularisation prior to hospital discharge, was achieved in 19 of 20 patients (95.0%).
  • There were no deaths or repeat revascularisations prior to hospital discharge.

My comment

This interesting study gives a glimpse into the future about the possibility to perform PCI not necessarily directly looking at the patient in the same physical location. This approach has been already explored in other medicine specialties and sometimes applied in clinical practice. To me it seems interesting for various reasons: firstly for the safety of the interventional cardiologists in terms of x-ray absorbed. Some CTO procedures may be performed with this approach. Secondly, it could be applied to perform PCI procedures in medically under-served regions, being potentially an alternative to inter-hospital transfer for primary PCI. The door-to-balloon time could be extremely reduced. Future studies are needed to further explore the feasibility and safety of this system, hoping that industries will be willing to invest in this field.

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