Kashif Ikram, MSc. MA. MBA had the opportunity to sit down and discuss simulation. As Head of Corindus Vascular Robotics EMEA at Siemens Healthcare GmbH, Kashif has led robotics in the surgical field for the past seven years. In this blog, he shares his thoughts on training and education as physicians transition into robotic-assisted vascular interventions.

Explain to the readers what Corindus does. 

Corindus is a Siemens Healthineers Company and global technology leader in robotic-assisted vascular interventions headquartered outside of Boston, Massachusetts. Our CorPath® platform is currently the only FDA-cleared and CE-marked robotic system for endovascular coronary and peripheral vascular interventions. It helps physicians precisely control guide catheters, guidewires, balloons, and stent implants under image guidance. 

In the same way, the commercial airline industry introduced technology to airplanes that made them safer to fly; medicine is transitioning from a predominantly manual model of care to one that integrates technology such as robotics, data-powered artificial intelligence, and computer vision to enhance the overall quality of care and drive appropriate levels of standardization for complex conditions. 

Robotic-assisted intervention benefits both the patient and physician by making procedures more precise and efficient and by limiting radiation exposure - 

Significant radiation reduction for patients and 95% radiation reduction for physicians has been observed with the implementation of the CorPath GRX System. Studies of CorPath® have shown a 99.1% clinical success in complex cases and a reduction in stent usage by 8.3%.1,2.

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In addition, incorporating automation into robotic-assisted procedures has shown early signs of helping to reduce procedure time associated with wire and device manipulation. Our recently released technIQ™ Smart Procedural Automation is a set of automated robotic movements designed for the CorPath® GRX System. The automation replicates the manual techniques of highly skilled interventionalists to provide predictable and consistent movements that aid in advanced navigation, lesion crossing, and device manipulation during complex coronary and peripheral interventional procedures.  

Also, robotically-enabled remote procedures have the potential to transform how we deliver care when treating some of the most time-sensitive illnesses. By working toward combining automation with remote robotics, we can potentially expand access to high-level care for emergent conditions such as heart attack and stroke, regardless of the patient’s location. The feasibility of this on the CorPath® technology platform has been demonstrated in early studies.3,4 

Imagine a “hub-and-spoke” model, where a physician at a comprehensive “hub” location can operate a robot at the smaller “spoke” location where the patient presented because it was closer to them. Delivering faster care could make a huge difference in the quality of life for that patient.  

Do you think the adoption of robotics within the interventional specialties will be faster than it has been for surgery, considering intervention is in some ways more suited to automation? 

I think there is an opportunity for us to expedite technology adoption in many areas of medicine. Any medical robotics company will tell you that producing and then certifying medical and surgical robotic technology is not simple, and rightly so. Corindus was started in 2002, and over the last 19 years, more than 100 of our systems have been installed worldwide, with nearly 10,000 cases performed. 

There is a supply and demand issue in medicine – aging baby boomers are creating more demand for specialized care, such as interventional cardiology, and an increasing number of cardiologists are approaching retirement age. Robotics will help to alleviate that strain on specialized care by increasing patient capacity for individual physicians.  The adoption cycles of advanced technology do become shorter and shorter as various technologies establish themselves in our day-to-day environment, and the hospitals are very much an important part of our ecosystem.  

"The Mentice simulator is a simple-to-use and intuitive device that enables you to experience in real-time a simulated interventional procedure. The trainee experiences a totally immersive and realistic experience of the procedure they are learning or the device they are testing. It is reproducible and can be used multiple times, providing advantages over alternative models such as animals or replicas."

What was your reason for starting to use Mentice simulators, and how are you using them today? 

The Mentice simulator is a simple-to-use and intuitive device that enables you to experience a simulated interventional procedure in real-time. The trainee experiences a totally immersive and realistic experience of the procedure they are learning or the testing device. It is reproducible and can be used multiple times, providing advantages over alternative models such as animals or replicas.  

We use Mentice simulators to explain the abilities of the Corindus CorPath® GRX to physicians. In that setting, they are used to demonstrate and practice various standard interventional cardiology and peripheral vascular intervention (PVI) procedures. These procedures are minimally invasive and of significant benefit to society.  

Since the simulators are portable, we have recently started to take them with us on the road, enabling us to demonstrate efficiently to many physicians in a short span of time. We have also used the simulators for R&D purposes, such as testing prototypes for performing remote procedures. Just as in the aviation industry, the virtual environment is an apt place to explore a new procedure, a new device, or simply sharpen and maintain your skills.  

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You mentioned the use of simulation for R&D and device testing. Are there also other areas where you could see valuable use cases? 

I think I can best answer that by discussing what we observe in other industries that use simulation. We see it with pilots, firefighters, other emergency workers, sports, and various commercial businesses. It all boils down to ensuring we are prepared; people are onboarded, rehearsed well, and enhance the standardization of best practices. Rare complications can be explored, and suboptimal methods eliminated. Gold standard treatments can be repeatedly practiced until they become second nature.  

I very much like the idea of replicating a rare or complex patient condition through simulation or a 3D printed model. Any learning pathway would be enhanced by including simulation and 3D printed models and advanced flow models. 

Last question – Will we ever get to fully automated systems like the “MedPod 720i” in the Ridley Scott movie Prometheus from 2012, and how long will it take in that case? 

While fully automated systems such as MedPod 720i or even the Emergency Holographic Doctor on Star Trek are fun to see, it is important to remember that these are not in the foreseeable future. Specialized physicians will always be at the forefront of medical practice and in control of all decision-making. Robots are tools that will support and enhance. Therefore, the need for physicians to learn and develop their skills will continue to be paramount.  

References: 

1 Harrison, et al., 2017, Robotically-assisted percutaneous coronary intervention: Reasons for partial manual assistance or manual conversion: https://pubmed.ncbi.nlm.nih.gov/29221959/  

2 Campbell, et al., 2015, The impact of precise robotic lesion length measurement on stent length selection: ramifications for stent savings: https://pubmed.ncbi.nlm.nih.gov/29221959/  

3 Patel, et al., 2019, Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience: https://pubmed.ncbi.nlm.nih.gov/31709402/  

4 Madder, et al., 2020, Network latency and long-distance robotic telestenting: Exploring the potential impact of network delays on telestenting performance: https://pubmed.ncbi.nlm.nih.gov/31410958/