Telerobotic neurovascular interventions with magnetic manipulation

Abstract

Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored because of technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial systems enable robotic manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications because of the considerably smaller and more tortuous anatomy of cerebral arteries. Here, we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance or retract the guidewire and a microcatheter, and a remote-control console to operate the system under real-time fluoroscopy. We demonstrate our system’s capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to physicians and open the possibility of remote procedural services to address challenges in current stroke systems of care.

Untethered small-scale magnetic soft robot with programmable magnetization and integrated multifunctional modules

“…Then, the magnetic soft robots are cut out from the double-sided adhesive, after which they are powered by a spatially nonuniform magnetic field. Within the actuating magnetic field, the 3D deformation of a soft robot is primarily driven by magnetic torques that align the local magnetization with the field direction, and then the magnetic forces increase or decrease the robot’s deformation depending on the relationship between the reoriented magnetization of the initially torque-driven deformation with the direction of magnetic field gradient ( 44 , 45 ). The magnetic response of the robot will either involve folding or continuous structural changes depending on whether it is programmed with uniform or nonuniform magnetization profiles, respectively.…”

Gradiometer-Based Magnetic Localization for Medical Tools

“…One of the common application areas of RMN is minimally invasive surgery. The high dexterity and precise tip control of magnetic catheters allow surgeons to successfully accomplish tasks that are otherwise very difficult to perform using their manually steered counterparts [1]- [4]. RMN also offers an ideal platform for automating various surgical procedures [5].…”

Using Magnetic Fields to Navigate and Simultaneously Localize Catheters in Endoluminal Environments

“…Magnetic actuation allows the catheters to be generally softer and more flexible than their manual counterparts thus reducing the risk of tissue damage during procedures. Forces can be directly applied to the magnetic tip of the catheter offering high dexterity and precision to navigate through complex structures [2], [3]. Hong et al [4], [5] demonstrated the benefits of a magnetically steered needle for deep brain stimulation by avoiding obstacles along the path.…”