Over the years, what we’ve realized is that the cath lab is by and large an unsafe environment. So the ability to perform the procedure in a radiation-shielded cockpit without having to wear a heavy leaded apron is a huge potential advantage in terms of an operator’s safety.
Additionally, when we do procedures in the cath lab, most of how we guide the placement of balloons and stents is through visual estimates. The robotic system actually offers us the ability to very accurately measure distances in the coronary realm — down to one-quarter of a millimeter — resulting in the ability to more accurately gauge what length of stent one needs to place and what length of balloon one needs to use. This may translate into potentially fewer stents per case since oftentimes we have to put in a second stent because the first stent is too short or long for the lesion. Also, because you’re sitting with the monitors at an ideal distance from your eyes, you actually see better with this system compared with traditional PCI.
In terms of how this will benefit patients, first and foremost, an operator who is working in a comfortable environment and not fatigued from standing all day wearing lead is a much better operator than one who at the end of the day can barely stand up. As many interventionalist cardiologists understand, the last case of the day is often not the best case because of the fatigue factor and issues related to eye strain and wearing a lead garment.
Although there is concern as to whether patients will accept the robotic-assisted PCI approach, ultimately I believe they will. In the clinical trial we had no trouble recruiting patients. In fact, one of the things we learned in this trial is that although it had been believed that the hands were what made interventional cardiologists great, it really isn’t; it’s their cognitive decision-making process. As you advance things like the wire, most of the time you’re making decisions as to whether or not to advance the wire based on what your eyes show, not what your hands feel, and we can actually translate very easily what we thought we were doing with our hands into the robotic system.
Joseph P. Carrozza Jr., MD
Chief, Cardiovascular Medicine
St. Elizabeth's Medical Center, Boston
Disclosures: Dr. Carrozza was the principal investigator for the PRECISE trial, which was sponsored by Corindus Vascular Robotics, but reports no relevant financial disclosures.