Shigeru Miyachi1, Yoshitaka Nagano2, Takahide Hironaka3, Reo Kawaguchi4, Tomotaka Ohshima4, Naoki Matsuo4, Ryuya Maejima4, Masakazu Takayasu4. 1. Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan. Electronic address: miyachi.shigeru.752@mail.aichi-med-u.ac.jp. 2. Department of Electronic Control and Robot Engineering, Aichi University of Technology, Gamagori, Aichi, Japan. 3. Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan. 4. Department of Neurosurgery and Neuroendovascular Therapy, Aichi Medical University, Nagakute, Aichi, Japan.
Abstract
BACKGROUND: Robotic technology is rapidly developing in the medical field, particularly contributing to support operative intervention using the da Vinci system during endoscopic surgery. Neuroendovascular intervention robot surgery is preferred when aiming to reduce radiation exposure among surgeons. METHODS: We developed a prototype of a support robot with 2 independent slaves manipulating both the microcatheter and microguidewire connected with the remote master driver with 2 joysticks. This design simulates usual catheterization with both hands. The slave manipulator has a sufficient output force >1 N to reproduce the exact master intervention without slip and delay. This machine has a unique function that indicates the reaction force of the resistance on wire stuck using the sensor system. We investigated the master-slave response, reliability of the force gauge, and degree of slippage of the slave motion on the table and checked the controllability, safety, and reproducibility of microcatheterization and insertion maneuver into the experimental aneurysm in the in vivo silicone vessel model. RESULTS: We realized the well master-slave response with a stable driving speed of the microguidewire at approximately 1 mm/s and with linear correlation between the output voltage and driving force. Also, we confirmed the well safety function to avoid the overloading to the vascular wall with the slippage of the slave roller on loading >1 N pushing force. Successful microcatheterization and insertion into the aneurysm model was performed in the wet vascular model corresponding to the 3-dimensional handling without excessive stress to the vascular or aneurysmal wall. CONCLUSIONS: Neuroendovascular intervention requires delicate power adjustment with fine finger control. Our support robot for neuroendovascular interventions demonstrated the accurate reproducibility of the operator's maneuver and safe operation in the vascular model using the sensor system. This system will realize the neurointervention without human operators in the AngioSuite and may facilitate telesurgery with remote control in the near future.
BACKGROUND: Robotic technology is rapidly developing in the medical field, particularly contributing to support operative intervention using the da Vinci system during endoscopic surgery. Neuroendovascular intervention robot surgery is preferred when aiming to reduce radiation exposure among surgeons. METHODS: We developed a prototype of a support robot with 2 independent slaves manipulating both the microcatheter and microguidewire connected with the remote master driver with 2 joysticks. This design simulates usual catheterization with both hands. The slave manipulator has a sufficient output force >1 N to reproduce the exact master intervention without slip and delay. This machine has a unique function that indicates the reaction force of the resistance on wire stuck using the sensor system. We investigated the master-slave response, reliability of the force gauge, and degree of slippage of the slave motion on the table and checked the controllability, safety, and reproducibility of microcatheterization and insertion maneuver into the experimental aneurysm in the in vivo silicone vessel model. RESULTS: We realized the well master-slave response with a stable driving speed of the microguidewire at approximately 1 mm/s and with linear correlation between the output voltage and driving force. Also, we confirmed the well safety function to avoid the overloading to the vascular wall with the slippage of the slave roller on loading >1 N pushing force. Successful microcatheterization and insertion into the aneurysm model was performed in the wet vascular model corresponding to the 3-dimensional handling without excessive stress to the vascular or aneurysmal wall. CONCLUSIONS: Neuroendovascular intervention requires delicate power adjustment with fine finger control. Our support robot for neuroendovascular interventions demonstrated the accurate reproducibility of the operator's maneuver and safe operation in the vascular model using the sensor system. This system will realize the neurointervention without human operators in the AngioSuite and may facilitate telesurgery with remote control in the near future.