| ObjectivesEndovascular surgery has become the main treatment method for vascular diseases with an obvious growing trend.While reducing the exposure time of the operators and improving the operation accuracy,the endovascular surgical robot assists with the endovascular surgery and has gradually become the research hotspot both domestically and worldwide;however,due to the wide range of endovascular surgery,various surgical methods and complex surgical instruments,existing clinical endovascular surgical robots are not compatible with commercially available endovascular instruments,such as guidewires,catheters and stents with different specifications;and cannot complete every single procedure,such as stent release,during an operation.Endovascular surgery has become the main treatment method for vascular diseases with an obvious growing trend.While reducing the exposure time of the operators and improving the operation accuracy,the endovascular surgical robot assists with the endovascular surgery and has gradually become the research hotspot both domestically and worldwide;however,due to the wide range of endovascular surgery,various surgical methods and complex surgical instruments,existing clinical endovascular surgical robots are not compatible with commercially available endovascular instruments,such as guidewires,catheters and stents with different specifications;and cannot complete every single procedure,such as stent release,during an operation.MethodsPart I: Adopting the in vitro biomimetic vessel model,the endovascular surgical robot was manipulated to complete simple actions such as advancement,rotation,and withdraw with commonly used endovascular instruments such as guidewire,catheter,sheath,balloon catheter,stent and filter of different sizes and brands,and complex actions that requires the cooperation of guidewire-catheter,guidewire-sheath,guidewire-stent,and etc.,and the completion of the action was accessed.Under the fine operation mode,the minimum step/minimum rotation of the guidewire was performed to measure the advancing and rotation accuracy of the endovascular surgical robot.Three operators with different clinical experience performed the fine operation to evaluate the difference of the operation raised by clinical experience.Part II: Adult pig was selected as experimental animal,and commercial endovascular instruments were used to perform coronary artery stenting,iliac artery stenting,carotid artery mechanical thrombectomy,aortic covered graft stenting,renal artery balloon expanded stenting,and inferior vena cava filter implantation using endovascular surgical robot.The X-ray exposure time of the operator and the extent of completion of the robotic operation were recorded to evaluate the performance of the endovascular robotic operation.In six different operations,the robot system completed a total of 336 endovascular procedures with100% success rate.And the robot system completed a total of 2045 robotic operations,and the invalid amount was 22.Among them,the invalid advance were 12 times and the invalid rotation 10 Times.The average effective rate of the entire experimental robot operation was99.2%.Part III: wireless local area network(WLAN)was built on the basis of the existing robot system,the endovascular robot was connected to the WLAN,the in vitro biomimetic vessel model was adopted,and the normal and fine endovascular operations were performed.The feasibility of robotic operation via WLAN was evaluated,the advancing and rotation accuracy was compared to that of wired operation,and the impact of different transmission medium on the fine operation was evaluated as well.ResultsPart I: In the in vitro biomimetic model,the forward,backward and rotating movements of total 4 kinds of guidewire,9 kinds of catheter and 4 kinds of balloon of different sizes,brands and materials were completed,and the in vitro release of aortic covered stent,peripheral artery bare stent and inferior vena cava filter was completed.In the fine in vitro experiment,the minimum advance distance of the three operators was(1.0±0.23)mm,(1.1±0.33)mm,(1.1±0.32)mm,the minimum rotation angle was(4.88±0.53)°,(4.80±0.72)°,(4.90±0.66)°,the average minimum advance distance was 1.07 mm,and the minimum rotation angle was 4.86°.Part II: Endovascular surgical robot in swine model can effectively operate endovascular instruments such as guidewire,catheter,balloon catheter,sheath,and filter with different sizes and brands,and Coronary artery stenting,iliac artery stenting,aortic covered stenting,carotid artery mechanical thrombetomy,renal artery balloon expanded stenting and inferior vena cava filter implantation were completed by human-machine collaboration.Except for puncture and sheath placement,replacement of instruments and balloon filling,all other operations were completed by robots.The average radiation exposure time of different operators was 14.17 s,and the average radiation exposure time accounted for 0.85% of the operative time.Postoperative angiography showed that the graft positioning was accurate,and no stent or operation-related adverse event were found.Part III: The endovascular surgical robot successfully completed the forward,rotating and backward movements of each executive arm and the forward,up and down,left and right movements of each executive arm under the WLAN.There were no system failure or error reporting due to the change of software or hardware.Through the minimum step and rotation operation,the average measured minimum advance distance was(1.1±0.23)mm;the average minimum rotation angle was(4.86±0.64)°,and there was no significant difference with that of the wired fine operation.ConclusionThis study completed the adaptability,accuracy and universality experiments via biomimetic vessel model that simulates the real operation scene,and verified the feasibility of treating different vascular diseases with endovascular surgical robot,as well as the advantage of the robot system,that is,in animal experiments,endovascular surgical robot can effectively reduce the operator’s X-ray exposure time and occupational exposure risk related complications,better verified the application of endovascular surgical robot in different vascular fields in swine model,which provides a practical basis for the transformation of clinical application in the future,and also lays a certain foundation for the future research of automated endovascular surgical robot.In this study,based on the existing robot system,the software and hardware of the robot were optimized to realize the effective control via WLAN;the feasibility of remote control of the robot system was verified by controlling the endovascular surgical robot under the wireless local area network to perform basic surgical operations,and the effectiveness of the robot’s fine operation was also guaranteed. |
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