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.

中文翻译：

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血管内动脉瘤修复患者手动与机器人辅助对侧门插管的比较

目的

机器人血管内技术可能比传统的手动导管技术更具优势。我们的目的是使用视频运动分析（VMA），比较血管内动脉瘤修复（EVAR）期间机器人对侧和手动对侧门插管的血管内导管路径长度（PL）。

方法

这是一项多中心回顾性队列研究，对来自欧洲四个主要中心的经验丰富的操作员（> 50个程序）进行了24例EVAR病例（14例机器人，10例手册）的荧光镜录像。各组可比，在动脉瘤大小（p  = 0.47）或血管曲折度（p  = 0.68）方面无统​​计学意义差异。两名受过训练的评估人员使用VMA来计算对侧门插管期间的机器人PL与手动方法的导管PL。

结果

有高度的观察者间可靠性（Cronbach的α  > 0.99）为VMA。机械手的中位PL为35.7 cm [四分位间距，IQR（30.8-51.0）]，而手动插管的中位机器人PL为74.1 cm [IQR（44.3-170.4）]，p  = 0.019。机器人病例的中位插管时间为5.33分钟[IQR（4.58–6.49）]，而人工病例的中位插管时间为1.24分钟[IQR（1.13–1.35）]（p  = 0.0083）。机械手产生的效率比（PL /主动脉centre中心线）为1.6（1.2-2.1），而人工情况下为2.6（1.7-7.0），p  = 0.031。

结论

与手动导管技术相比，EVAR中的机器人辅助对侧门插管可缩短导航路径的长度并增加运动的经济性。通过优先考虑机器人导管的成形而不是习惯于对导线的操纵，可以最大程度地提高收益。机器人技术具有减少零辐射暴露的优势，即使对于有经验的操作员，也有可能减少操作过程中的血管内足迹。