Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm r
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ORIGINAL ARTICLE
Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair Sheena Cheung1 · Rafid Rahman1 · Colin Bicknell1,2 · Danail Stoyanov3 · Ping-Lin Chang3 · Mimi Li1 · Alexander Rolls1 · Liesbeth Desender4 · Isabelle Van Herzeele4 · Mohamad Hamady2 · Celia Riga1,2,5 Received: 12 February 2020 / Accepted: 7 August 2020 © CARS 2020
Abstract Purpose Robotic endovascular technology may offer advantages over conventional manual catheter techniques. Our aim was to compare the endovascular catheter path-length (PL) for robotic versus manual contralateral gate cannulation during endovascular aneurysm repair (EVAR), using video motion analysis (VMA). Methods This was a multicentre retrospective cohort study with fluoroscopic video recordings of 24 EVAR cases (14 robotic, 10 manual) performed by experienced operators (> 50 procedures), obtained from four leading European centres. Groups were comparable with no statistically significant differences in aneurysm size (p 0.47) or vessel tortuosity (p 0.68). Two trained assessors used VMA to calculate the catheter PL during contralateral gate cannulation for robotic versus manual approaches. Results There was a high degree of inter-observer reliability (Cronbach’s α > 0.99) for VMA. Median robotic PL was 35.7 cm [interquartile range, IQR (30.8–51.0)] versus 74.1 cm [IQR (44.3–170.4)] for manual cannulation, p 0.019. Robotic cases had a median cannulation time of 5.33 min [IQR (4.58–6.49)] versus 1.24 min [IQR (1.13–1.35)] in manual cases (p 0.0083). Generated efficiency ratios (PL/aorto-iliac centrelines) was 1.6 (1.2–2.1) in robotic cases versus 2.6 (1.7–7.0) in manual, p 0.031. Conclusion Robot-assisted contralateral gate cannulation in EVAR leads to decreased navigation path lengths and increased economy of movement compared with manual catheter techniques. The benefit could be maximised by prioritising robotic catheter shaping over habituated reliance on guidewire manipulation. Robotic technology has the potential to reduce the endovascular footprint during manipulations even for experienced operators with the added advantage of zero radiation exposure. Keywords Endovascular · Innovation · Aneurysm · Robotics
Sheena Cheung and Rafid Rahman are joint first authors.
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Alexander Rolls [email protected]
Celia Riga [email protected]
Liesbeth Desender [email protected]
Sheena Cheung [email protected]
Isabelle Van Herzeele [email protected]
Rafid Rahman [email protected] Colin Bicknell [email protected] Danail Stoyanov [email protected] Ping-Lin Chang [email protected] Mimi Li [email protected]
Mohamad Hamady [email protected] 1
Division of Surgery and Cancer, Imperial College London, London, UK
2
Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
3
Centre for Medical Image Computing, University College London, London, UK
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International Journal of Computer Assisted Radio
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