Masterclass #14: Robotic procedures: An unbeatable precision tool and/or a remote replacement for human intervention?

Jens FIEHLER, Pascal JABBOUR, Vitor MENDES PEREIRA, Jacques MORET, Laurent SPELLE

If you were a patient, would you accept a robotic-assisted procedure? With this question Professors Jacques Moret and Laurent Spelle begin a special Masterclass dedicated to the frontier of interventional neuroradiology procedures – the use of robotics. With an international panel including experts experienced in the field, this Masterclass is illustrated by recorded live cases performed by Vitor Mendes Pereira using the CorPath Robotic System.

• What role do we see for robotics today?
• Is it the ability to protect health professionals from radiation exposure, to augment human capabilities and skills?
• Is our goal to enhance human performance in our local cathlabs or to be able to perform remote procedures, such as stroke management, in rural, underserved, areas?

How do we convince a patient to allow a robotic system to be used? What would be the best patient to choose, and which specific cases have the potential of offering the best results?

How do we design randomized studies to test robotics? Should we begin with a non-inferiority trial? A safety study?

What outcomes and endpoints do we wish to attain? Aneurysm occlusion? Radiation time?

What are the best metrics to consider? Are there any studies ongoing today?

As the cases unfold, learn what differentiates the robotic approach from current practice:

• How steep is the learning curve for using touch screens and joysticks?
• Can the lack of haptic feedback be compensated by our “visual” reflexes? Is the value of the enhanced vision underestimated?
• What takes the longest to get accustomed to? The controls, or learning to trust the bedside team?

What are the current limitations for the use of robotics?

• Do we need different devices, such as longer catheters?
• Do these robots offer the possibility of multi-microcatheter controls or dual access? How does that limit the cases in which robotic assistance can be employed?

What currently stands in the way of robotic use in remote locations?

• Connectivity?
• Training of local staff?
• How would we handle complications that occur during a remote procedure?

What are the ethical questions involved?

• How will this change our healthcare systems?
• Will it create centers with super specialists? Centralization, quantification of care?
• Can the cost be justified by increasing coverage or offering better care?

Can robotics be seen as a training tool?

Medicine, as Prof Moret says, is a “technical act and an inseparable human relationship”. What happens if we separate them?