Advances in robotic technology have been adopted in various subspecialties of both open and minimally invasive surgery, offering benefits such as enhanced surgical precision and accuracy with reduced fatigue of the surgeon. Despite the advantages, robotic applications to endovascular neurosurgery have remained largely unexplored because of technical challenges such as the miniaturization of robotic devices that can reach the complex and tortuous vasculature of the brain. Although some commercial systems enable robotic manipulation of conventional guidewires for coronary and peripheral vascular interventions, they remain unsuited for neurovascular applications because of the considerably smaller and more tortuous anatomy of cerebral arteries. Here, we present a teleoperated robotic neurointerventional platform based on magnetic manipulation. Our system consists of a magnetically controlled guidewire, a robot arm with an actuating magnet to steer the guidewire, a set of motorized linear drives to advance or retract the guidewire and a microcatheter, and a remote-control console to operate the system under real-time fluoroscopy. We demonstrate our system’s capability to navigate narrow and winding pathways both in vitro with realistic neurovascular phantoms representing the human anatomy and in vivo in the porcine brachial artery with accentuated tortuosity for preclinical evaluation. We further demonstrate telerobotically assisted therapeutic procedures including coil embolization and clot retrieval thrombectomy for treating cerebral aneurysms and ischemic stroke, respectively. Our system could enable safer and quicker access to hard-to-reach lesions while minimizing the radiation exposure to physicians and open the possibility of remote procedural services to address challenges in current stroke systems of care.

中文翻译：

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磁操纵遥控机器人神经血管干预


机器人技术的进步已在开放式和微创手术的各个亚专业中得到采用，带来了诸如提高手术精度和准确度以及减少外科医生疲劳等好处。尽管有这些优势，但由于技术挑战，例如可以到达大脑复杂而曲折的脉管系统的机器人设备的小型化，机器人在血管内神经外科手术中的应用在很大程度上仍未得到探索。尽管一些商业系统能够实现冠状动脉和外周血管介入治疗中传统导丝的机器人操作，但由于脑动脉的解剖结构相当小且更加曲折，它们仍然不适合神经血管应用。在这里，我们提出了一种基于磁操纵的遥控机器人神经介入平台。我们的系统由磁控导丝、带有致动磁铁来操纵导丝的机器人手臂、一组用于推进或缩回导丝和微导管的电动线性驱动器以及一个用于在实时情况下操作系统的远程控制台组成。时间透视。我们展示了我们的系统能够在体外通过代表人体解剖结构的真实神经血管模型和在体内猪肱动脉中导航狭窄而蜿蜒的路径，并在临床前评估中强调弯曲度。我们进一步展示了远程机器人辅助治疗程序，包括弹簧圈栓塞和血块取出血栓切除术，分别用于治疗脑动脉瘤和缺血性中风。 我们的系统可以更安全、更快速地接触难以到达的病变，同时最大限度地减少医生受到的辐射暴露，并开启远程程序服务的可能性，以应对当前中风护理系统的挑战。