Canadian doctors who conducted the first robotic surgery to treat a brain aneurysm say the approach could boost the availability and precision of lifesaving stroke care.
Use of the technology could also be a first step toward remote robotic surgery for stroke and other conditions affecting brain blood vessels.
"In the future, perhaps, a patient could end up in a small centre somewhere, and the staff there could put the patient into the appropriate suite where the procedure can be done," explained American Heart Association president-elect Dr Mitchell Elkind. "And then, an expert at another site, perhaps hundreds or even thousands of miles away, could perform the procedure remotely. It's really like science fiction stuff. It sounds really exciting and it has great potential."
Elkind wasn't involved in the new report, which was led by Dr Vitor Mendes Pereira, a neurosurgeon and neuroradiologist at the Toronto Western Hospital. His team presented their findings at the International Stroke Conference, in Los Angeles.
A stent in the affected artery
As the Canadian doctors explained, robotic technology is already used in many surgeries, including cardiac procedures. But it has not yet been tried in delicate neurovascular surgeries – procedures on brain blood vessels.
The Toronto team reported on the case of a 64-year-old woman with an unruptured aneurysm at the base of her skull.
An aneurysm is a bulge in the wall of an artery that, if it ruptures, can lead to dangerous bleeding or death.
Mendes Pereira's group used a robotic arm to place a stent in the affected artery and then used the same "microcatheter" to enter the aneurysm and make it more secure through the placement of various coils.
Since that first case, the team said they have successfully performed five more aneurysm treatments using the robotic arm, including the placement of various devices such as stents that more safely divert blood flow.
"This experience is the first step towards achieving our vision of remote neurovascular procedures," Mendes Pereira said in an American Stroke Association news release. "The ability to robotically perform intracranial aneurysm treatment is a major step forward in neuro-endovascular intervention," he explained.
"The expectation is that future robotic systems will be able to be controlled remotely. For example, I could be at my hospital and deliver therapy to a patient hundreds or even thousands of kilometres away," Mendes Pereira said.
Two cardiologists not involved in the new report said robotic stroke care should speed lifesaving interventions to more patients.
"This technology may help eliminate the need for the transfer [of patients to a specialty hospital], thus enabling faster treatment and potentially saving millions of neurons," explained Dr Keith DeSousa, director of neuro-endovascular services and the neurovascular program at Southside Hospital in Bay Shore, New York.
He called the advent of robotic stroke care "an essential next step forward for this field."
Dr Rafael Ortiz is chief of neuro-endovascular surgery at Northwell Health's Manhattan and Westchester regions, in New York City. He agreed that "robotic neuro-endovascular surgery expands the capability for surgeons to perform procedures remotely, specifically in underserved regions of the world."
According to Mendes Pereira, "The ability to deliver rapid care through remote robotics for time-critical procedures such as stroke could have a huge impact on improving patient outcomes and allow us to deliver cutting-edge care to patients everywhere, regardless of geography."
He concluded that his team's "experience, and that of future operators of this technology, will help develop the workflows and processes necessary to implement successful robotic programmes, which will ultimately help establish remote care networks in the future."
Because the new report was presented at a medical meeting, its findings should be considered preliminary until published in a peer-reviewed journal.
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