Robot or not robot!
The Niobe Magnetic Navigation System combines the advantages of steering the device from the distal end with the 3D integration of the anatomy in order to improve the PCI experience and is reported to enable new and more complex interventional procedures.
Abstract
Percutaneous cardiac intervention (PCI) is the result of the manipulation of a device from a remote position with a ‘‘3D integration’’ of the anatomy and the specific ‘‘art’’ of steering the device (operator technical skill).The obstacles arise from the anatomy and the remote steering of the device. The Niobe Magnetic Navigation System combines the advantages of steering the device from the distal end with the 3D integration of the anatomy in order to improve the PCI experience: ‘‘The orientation of these devices is controlled by precise manipulation of the field generated by two large neodymium-iron-boron magnets that are mounted on mechanical positioners on either side of the patient. Rotation and translation of these magnets maintain a net magnetic field of 0.08-T within a 20-cm diameter sphere in the patient’s upper thorax [1].’’ What is Stereotaxis technology? Magnetic navigation is an interaction between a tiny magnet in the tip of the interventional device and a magnetic field of specified direction and magnitude, positioned externally to the patient. Magnets are rotated to change field orientation (as an automatic advancement system automatically controls catheter advancement and retraction— eliminating any pulling or pushing on he interventional device); the end result is alignment of the distal tip of the magnet with the field direction—literally steering catheters and guide-wires through the vasculature. The potential advantages over manual navigation are the following: It does not rely on physician dexterity and enhances device flexibility by making turns 908 or sharper; device controlled at the distal tip; addition of automated advancement system supports remote navigation and then radiation exposure for physicians (and patient) is reduced; digitally integrated platform may lead to increased cath-lab productivity [1–3]. The clinical value of such a tool will be to enable new and more complex interventional procedures (integration of 3D imaging of target vessel and CT/MRI image importation and registration to fluoro), reduce time for existing procedures reduce amount of contrast used, and reduce staff-patient X-ray exposure and permit remote control. The article by Kiemeneij reported the real life experience and feasibility of this system demonstrating the necessary learning curve required to independently steer before pushing [1]. The limitation of this technology will finally reside on the ability of interaction between different industries to optimize the hardware.