In 2018, five patients at the Apex Heart Institute in Ahmedabad, India, received treatment for coronary artery disease (CAD) the same way 3 million others do each year: a small balloon was inserted into an artery in the heart and inflated, making way for the placement of a stent to keep the vital pathway open.
The procedure, known as percutaneous coronary intervention (PCI), is the standard treatment for atherosclerosis, a common CAD marked by the buildup of plaque inside the arteries and a subsequent restriction of blood flow. Like many patients before them, their operation was assisted by a robot—the CorPath GRX robotic platform fromCorindus，西门子Healthineers公司.
Yet unlike anyone else before them, these five patients were part of an amazing first: their principal physician was not in the room with them during the procedure. In fact, he was 20 miles away, guiding the robot—performing the operation to perfection—from a remote workstation.
欢迎来到远程医疗的新边疆。
机器人手术解决了导致死因
根据世界卫生组织（世卫组织），心血管疾病（CVD）是全球死亡人数，每年申请1790万人生命。在缺乏准备好的关键护理，如发展中国家和农村地区，影响是最大的影响。
The WHO notes that over three-quarters of deaths from CVD occur in low- and middle-income countries. In developed countries, the issue arises in rural communities where smaller hospitals often do not have specialists, such as interventional cardiologists, on staff. It is in these areas where remote solutions like the one Corindus has pioneered offer hope and tantalizing possibilities.
Tejas Patel博士进行了这些远程干预措施，并用他的同事Sanjay Shah和Samir Pancholy写了一篇关于他们EClinicalMedicine. According to the article, “The vast majority of patients with CAD or acute coronary syndrome in developing countries have little or no access to immediate interventional therapy. Current robotic technology combined with improvements in network connectivity and operator expertise in R-PCI [robot-assisted PCI] procedures can be employed as a front-line service in regions where such expertise is not available.” The article also noted that the system could be used as a supplemental service to provide expertise to a larger number of patients.
Physician driving CorPath GRX from the interventional cockpit. Image Credit: Corindus
According to the WHO, cardiovascular disease is the number one cause of death globally, claiming 17.9 million lives per year.
“Go Remote or Go Home”
Reaching patients around the world wherever and whenever they need treatment has been on the mind of the Corindus team since the introduction of their CorPath robotic platform. So has physician safety.
While CorPath’s robotic advances have provided physicians with exceptional precision and control during PCI procedures, the system still needed to do more to safeguard physician health—exposure to radiation from imaging techniques used in the procedures was common, as were orthopedic injuries stemming from the necessary heavy protective equipment doctors were forced to wear.
“Sensing an opportunity to increase the safety of surgeons while at the same time addressing the growing global need for innovative telemedicine solutions, Corindus CEO Mark Toland famously told our team that it was time for us to ‘go remote or go home,’” recalls Nicholas Kottenstette, Ph.D., R&D Fellow at Corindus. “This battle cry resonated across the company, forcing us to push the envelope, further evolve the capabilities and possibilities of our CorPath system, and achieve another industry milestone: enabling the first remote robotic-assisted PCI.”
Technology for Aircraft Control Leads to Robotic Surgery
Kottenstette has worked on the robot product line since joining Corindus. But he started his career in a different field. He received his Ph.D. in electrical engineering at Notre Dame, where he designed a framework to control systems over networks, ensuring stability while accounting for time delay and data loss. He then began his career at Vanderbilt University, developing robotic control systems for aircraft using Model-Based Design. It was this work that led to a different type of control system that operated over the network: the surgical robot.
“All of that work, which involved Model-Based Design using MATLAB®and Simulink®, has proven integral to meeting the challenges of developing our precision robotic systems,” says Kottenstette.
To understand the complex workings of the robotic system, it helps to take a basic inventory of its key components. The system comprises two main stations: a bedside unit, the part of the system which allows for device manipulation within the patient, and an interventional cockpit, from which the physician guides the devices during an intervention.
床头柜有一个伸展的伸展臂和床边触摸屏。这由磨砂员工运营。图像学分：Corindus
The interventional cockpit comprises a radiation shield, monitor, and control console that enable the interventional cardiologist to work from a seated position without wearing lead. Image Credit: Corindus
The CorPath GRX robotic platform comprises two main stations: a bedside unit, the part of the system which allows for device manipulation within the patient, and an interventional cockpit, from which the physician guides the devices during an intervention.
The bedside unit consists of the extended reach arm, the robotic drive, and the single-use sterile cassette. The arm positions the robotic drive and cassette. The robotic drive, which receives inputs from the control console in the cockpit, guides the cassette, which in turn manipulates the guidewire, balloon/stent catheter, and guide catheter in the patient’s body.
The interventional cardiologist works from the interventional cockpit, which contains both the robot control subsystem and a telepresence communication system, and links the physician to the robot in the bedside unit.
“机器人控制变电站包含一个控制计算系统，监视器，网络设备（即连接）和带有三个操纵杆的机器人控制台，”Patel博士说。“监视器显示实时血液动力变量和荧光透视视频，提供操作员增强了PCI过程的可视化。一个操纵杆用于气球/支架操作，一个用于导丝操纵，以及第三个用于导管操纵。“
A closer look at these two main systems—the bedside unit and interventional cockpit—reveals a collaboration and interdependence essential to the successful performance of the robotic system. Combined, these systems have delivered quantifiable benefits, including increased accuracy in measuring anatomy to determine lesion size and stent length, and increased precision in stent positioning.
“All of that work, which involved Model-Based Design using MATLAB and Simulink, has proven integral to meeting the challenges of developing our precision robotic systems,”
尼古拉斯kottenstette，Ph.D.，Corindus的研发人员
Long-Distance Surgery
Performing an intricate procedure remotely posed significant design challenges, chief among them real-time, end-to-end video capture and processing: physicians may operate less effectively when there is significant lag or latency in the images they see and commands they send over a network. In addition, it is important that the physician is aware of the quality of the network connection, which includes network latencies and received frames of images per second (throughput). The system should limit the physician from operating under poor networking conditions in order to limit risks of patient harm.
为了克服实时系统运营的挑战，Kottenstette利用基于模型的设计制作了创新的追踪记录。
“MATLAB, Simulink, and Simulink Real-Time™ have long been staples of my application-development work on the CorPath system, from embedded motor controls for guiding the robotic arm’s motions, to the way the flourscopic images are communicated with the workstations,” says Kottenstette. “My team modeled the remote system using Model-Based Design.”
这种方法已经支付了股息。例如，随着Corindus开始开发其下一代平台，它在对USB 3.0设备实时支持之前，它使用通用相机。金宝app
“As we pushed to develop an advanced real-time video capability that didn’t interrupt the physicians’ normal workflow, MathWorks worked hand in hand with us to develop the needed support,” says Kottenstette. “Once we had that, we could compress and decompress images as needed to facilitate their real-time transmission and consumption by the remote operator.”
As for ensuring a dedicated real-time network capability, Corindus used the Speedgoat family of target machines—high-performance computers optimized for specific applications—to execute his system’s mission-critical applications. With a Speedgoat target at the operating site and one at the remote location, where it supported the interventional cockpit, CorPath GRX performed admirably.
帕特尔博士在他的报告中说明，“远程R-PCI程序在所有方面都成功。远程介入者操作员评定了机器人平台的功能和网络连接系统等同于实验室手册PCI程序，没有显着的程序延迟或技术难题。这是由网络记录的53毫秒均值延迟的证实，这对操作员来说很可能是不可察觉的。“
th Kottenstette设计仿真软件的金宝app实时模型at control the bedside unit.
“MATLAB, Simulink, and Simulink Real-Time have long been staples of my application-development work on the CorPath system, from embedded motor controls for guiding the robotic arm’s motions, to the way the fluoroscopic images are communicated with the workstations. My team modeled the remote system using Model-Based Design.”
尼古拉斯kottenstette，Ph.D.，Corindus的研发人员
Encouraged by its breakthrough success with remote R-PCI procedures, Corindus is continuing to think big—big enough to lead a telemedicine revolution in brain treatment as well.
“冲程受害者的每一秒事项，就像那些遭受心脏病发作的人一样，”Kottenstette说。“我们在远程机器人协议的任何地方治疗患者的能力是未来的浪潮，正在推动我们的下一组集团创新，因为我们采取笔画，这是残疾人的头号和第五个导致死亡原因the U.S.”
Watch this video(3:11)要了解Corindus如何在SpeedGoat目标上运行实时应用程序，使用精密时间协议同步本地和远程站点时钟。
