Recent studies have featured the benefits of robotic PCI as a feasible way to treat CAD. But at the annual TCT conference Oct. 30, Ryan D. Madder, MD, presented the idea of “tele-stenting” over long distances. Is it possible for an operator in one part of the country, using robotic technology, to perform a PCI on a patient across the country? What about across the world?
The Current State of Tele-stenting
As the lead investigator of the REMOTE-PCI study, Madder demonstrated that operators can perform PCI while in a separate area from the patient. In the study, the distance was simply across the hall or an adjacent room of a cath lab. But this was only because the robotic technology used in the study required a hardwire connection between the system and the interventional cockpit from which the operator controls the system.
To perform these operations remotely, not just from the next room, the bedside robotic arm would need to be connected to the cockpit control center through a web-based network. The technology does exist, Madder himself pointed to a case from 2001 called “The Lindbergh Operation” wherein an operator in New York performed a robotic laparoscopic cholecystectomy on a patient in France.
“I would argue with all the advances that have been made in internet connectivity, we can probably figure out how to do tele-stenting now,” said Madder, who directed the study on behalf of Corindus Vascular Robotics.
Is Remote Robotic PCI Even Necessary?
The biggest and most important question is: “should we? The PCI was first performed over 40 years ago and has become the most commonly prescribed procedure in interventional cardiology. Aren’t there enough skilled human operators that spending significant money for a second-generation technology like this, is frivolous or wasteful?
While cost is one factor, there are other benefits that must be considered. By removing the interventionalist from the patient’s side, you are also reducing exposure to radiation by up to 97%. Previously, we have discussed that radiation exposure is one deterrent for new physicians entering the profession. There has been great technological success and geographical limitations can also be avoided.
The Next Steps
All of the discussion about remote PCI is sheerly speculative for now, while technology is tested and techniques are perfected. Newer technology is also emerging quickly. Training programs will have to be developed, considering the learning curve for new users of the technology is about three to five cases for simple lesions and 20 to 25 cases for complex lesions. And there are still more device-specific improvements to be made. Regardless, this is a super exciting prospect.
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