This week the FDA gave their blessing to the first robotic system to drive wires, catheters, balloons and stents from groin incisions all the way up to coronary arteries. This procedure called PCI, percutaneous coronary interventions (better known as angioplasty), restores blood flow to patients with coronary artery disease.
Cardiologists were delighted with the announcement. Up till now they had been weighed down by heavy lead aprons and vests to guard against fluoroscope exposure to radiation during the x-rayed procedure. With this new robotic system by Corindus Vascular Robotics, however, doctors were now transported to the safety of lead-lined cockpits where they could comfortably control PCI devices using touch-screens and joysticks.
This was obviously advantageous for doctors. But I wondered about the patients. None were shown in any of the promo diagrams, photos or videos going through the actual procedure. What I specifically wondered was, with the doctor now holed up in his insulated cockpit, who if anyone was left standing beside the patient. Once cardiologists were allowed to leave the patients side for their own safety, it’s hard to imagine nurses wouldn’t receive the same benefit. So if no one was left standing there, who was going to jump in if something went wrong?
That “something” could be a problem with the dye the doctor injects into the coronary arteries to pinpoint narrow openings. This dye problem actually popped in up in my own case during a CAT Scan. A nurse inserted an IV into my arm, then high-tailed it out of the x-ray room for the lead-lined safety of a control booth. From there, she started the contrast dye flowing into my vein. Immediately my arm burned with a disturbing red-hot sensation. It took me a few moments to process this (was it normal? Was I supposed to feel this intense pressure?) But as the burning pressure increased and turned into pain, I called out, “I think something’s wrong with the dye here.” The nurse brushed off my alarm with, “The pressure will ease off in a second.” But it didn’t and I yelled out again that she needed to look at it. Bristling with annoyance (medical personnel do NOT like patient interruptions during test procedures), she left her sealed-in booth and examined my arm, which had suddenly taken on the shape of a football. It turned out the dye had infiltrated. Instead of being injected into my vein, her needle had missed and the dye had flowed into surrounding tissue.
And with this new robotic system, no human was doing the injecting. A robot was.
Another possible problem could involve the tiny size of the heart blood vessels which can be only 3 to 4 millimeters in diameter — pretty narrow for catheters and wires and stents to pass through. As a doctor himself said on a Corindus video, the veins they were dealing with were so small that any small mistake could quickly lead to a bigger problem. And if one of those “bigger problems” suddenly occurred and surgical intervention was necessary, how fast could the doctor (and additional necessary personnel) get to the patient?
Perhaps these were merely worrywart concerns. Perhaps not. We don’t have long to wait to know. From the looks of the successful trials and the enthusiastic acceptance of physicians, these coronary robots will soon be starring front and center in operating rooms near you.
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