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Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

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.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Sheena Cheung and Rafid Rahman are joint first authors.

Authors and Affiliations

  1. Division of Surgery and Cancer, Imperial College London, London, UK

    Sheena Cheung, Rafid Rahman, Colin Bicknell, Mimi Li, Alexander Rolls & Celia Riga

  2. Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK

    Colin Bicknell, Mohamad Hamady & Celia Riga

  3. Centre for Medical Image Computing, University College London, London, UK

    Danail Stoyanov & Ping-Lin Chang

  4. Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium

    Liesbeth Desender & Isabelle Van Herzeele

  5. 1003 Queen Elizabeth The Queen Mother Wing (QEQM), St Mary’s Hospital, Praed St, Paddington, London, W2 1NY, UK

    Celia Riga

Authors
  1. Sheena Cheung
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  2. Rafid Rahman
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  3. Colin Bicknell
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  7. Alexander Rolls
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  10. Mohamad Hamady
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  11. Celia Riga
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Corresponding author

Correspondence to Celia Riga.

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All authors have read and approved this manuscript and there are no conflicts of interests.

Ethical approval

This study was approved by the respective Ethics Committees in each of the institutions involved and in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all study participants.

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Cheung, S., Rahman, R., Bicknell, C. et al. Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair. Int J CARS 15, 2071–2078 (2020). https://doi.org/10.1007/s11548-020-02247-3

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  • DOI: https://doi.org/10.1007/s11548-020-02247-3

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