As the Director of Product Management at Corindus, part of my job is to think about the future: how can Robotics help make interventions safer, more precise, better? How can we continue to build on what CorPath is accomplishing today at sites across the US by developing future generations to expand the impact even further -- both within PCI (percutaneous coronary interventions) and beyond?
Considering the future, for me, starts with truly understanding how interventionalists work today: Where does robotic precision have the most impact? What’s working well, and where do they need additional help? I’ve had the opportunity to observe a number of robotic and manual interventions, watching and listening for user needs. Often, my attention is on what the physician is most focused on – the patient.
A particularly talkative patient during a recent case got me thinking about the future in a different context … what if one day it’s me or a loved one on that table? How would I feel about a robotic interventional procedure that hits closer to home?
I decided to check in with some of those loved ones, starting with my mom. A 73-year old former Kindergarten teacher, she’s not exactly an early adopter of technology. In discussing the CorPath with her, I explained how the physician controls the balloons and stents using joysticks, from a radiation-protected cockpit. The benefit to the doctor was immediately apparent to her. But the unexpected part for me was that my mom immediately presumed that a robotic procedure would be more precise. Never having seen the CorPath, she intuited that robotic movements would be more exact than manual, and felt this idea would be comforting to patients.
The next interviewee was my husband. As an aerospace engineer who has spent part of his career designing robots himself, my husband is definitely an early adopter of technology. It can come in handy to have in-house tech support, but you might be surprised at the confusion that can ensue when your house is controlled by your smartphone. But that’s another story. My husband’s reaction to my question was (perhaps predictably), analytical: “How exactly does the robot work?” (Queue our latest animation). “How do you ensure it’s safe?” (Multiple layers of safety mechanisms); “OK, that’s good … What if there is a power loss?” This went on for a little while … my husband is now fully informed, and fully on board to have a robotic-assisted PCI should the need arise.
I could not resist asking the same question to the head of R&D at Corindus. He would not be hurt to know I don’t include him as one of my “loved ones” (although I like him very much). I wanted to ask him because he’s been involved in the development of the CorPath for years, and knows the technology inside and out. The conversation was brief. When I asked:
“If you were a patient and needed a PCI, would you want it done robotically with the CorPath System?”
He did not hesitate in answering:
OK, so perhaps his answer was also somewhat predictable. But the definitiveness of the answer is based on deep design experience and data from >300 CorPath cases. The PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention Study) multicenter trial studied the safety and efficacy of CorPath-assisted PCI 1. There were zero device-related complications, and compared to historical data from manual PCI procedures2, PRECISE showed fewer stents required per lesion, less fluoroscopy time, and less contrast used.
The implications for patients go far beyond the PRECISE Trial data. We know from previous studies that in PCI, placing the correct-length stent, precisely in the correct location, has an impact on long-term patient outcomes3. As more, and increasingly complex, procedures are done percutaneously, several factors point to the growing clinical value of robotics in the future:
1) Need for higher precision control, such as when deploying catheter-based heart valves or neurovascular stents
2) Increasing amount of data that’s acquired or processed during the procedure. Imaging modalities might include single- or bi-plane fluoroscopy, CT, IVUS, TEE, OCT; add three-dimensional imaging and the complexity grows. The ability to visualize and manipulate this data in a seated, radiation-protected environment implies a real improvement for the physician, for decision making, and by extension for patient outcomes
3) Requirement for quantitative measurements over “eyeballing”
4) Longer procedures, and the associated ergonomic and radiation safety implications
5) Cost – need to select the correct-size device and place it successfully, the first time
I recently met a physician who is organizing a summit on “The next 50 years of image-guided interventions”. After spending considerable time analyzing many of the factors above and more, he has concluded that “robotics will play a major role in the future of image guided interventions”. We agree.
After considering the future and asking others how they would feel as a patient, all that was left was to look inward. Would I want my heart in the hands of a robot?
The truth is, my heart would not be in the hands of a robot. It would be in the hands of an experienced physician – except now he or she would not be weighed down by 10 pounds of lead, bent over the patient bed working to see my coronary arteries on a monitor that’s a meter away. My physician would be sitting comfortably, looking at a monitor right in front of him, using a robotic tool to make controlled movements and measurements with sub-millimeter precision.
So, yes, after reflecting on the question: “If one day I’m the patient needing an intervention, would I want it done robotically with the CorPath System?” My answer is also: “Absolutely”.
What is your answer?
1 Weisz G, et al. Safety and Feasibility of Robotic Percutaneous Coronary Intervention. J American College of Cardiol, 2013, Vol 61, No. 15: 1596-1600
2 Nikolsky E, Pucelikova T, Mehran R, et al. An Evaluation of fluoroscopy time and correlation with outcomes after percutaneous coronary intervention. J Invasive Cardiol, 2007, 19: 208-213
3 Costa M., et al,. (2008) Impact of Stent Deployment Procedural Factors on Long-Term Effectiveness and Safety of Sirolimyus-Eluting Stents (Final Results of the Multicenter Prospective STLLR Trial). Am J Cardiol, 101(12):1704-11