Improving stroke care with telerobotics will require changes in technology, clinical operations and regulations.
By Dr. Vitor Pereira, St. Michael’s Hospital and University of Toronto
Recently, I participated in the world’s first demonstration of a mechanical thrombectomy procedure using telerobotics. From a control panel in Abu Dhabi, I
successfully performed a robotic-assisted procedure on a simulated patient in South Korea
.
A telecom-connected network of surgeons and robotic platforms could significantly extend each surgeon’s reach and enable quicker patient access to these specialists.
However, creating a true telerobotic network will require extensive cross-border coordination and a commitment to innovative technology, representing a shift for the traditionally conservative healthcare industry.
To create more time, we need a new stroke care model
Stroke remains the second leading cause of death globally despite compelling evidence of effective treatments – most notably, mechanical thrombectomy. However, patients can only achieve the best outcomes when they present to a certified stroke treatment facility shortly after the onset of symptoms.
Neurosurgeons live by the adage “time is brain” because the brain loses about 2 million neurons per minute after an acute ischemic stroke, the most common type of stroke. We must race against the clock as every passing second increases brain damage and, consequently, the level of disability the patient may face if they survive. We cannot stop the clock, and the damage caused by a stroke can be irreversible.
Our traditional hospital infrastructure, with specialists and large health systems concentrated in major cities in affluent countries, limits patients’ access to care. Patients living outside major metropolitan areas face long travel distances to receive timely care. The U.S. only has about 300 comprehensive stroke centers serving a population of over 300 million, leaving patients in many Midwestern and Southern states highly vulnerable to worst-case-scenario outcomes if they experience a stroke.
To reduce treatment times and increase patient access to gold-standard therapy, we must rethink our current system for care delivery.
Fast, reliable connectivity
Advances in internet connectivity have made telerobotic procedures more feasible. Our telecommunications infrastructure has evolved to support procedures that were not possible two decades ago.
Neurovascular procedures require precise navigation through delicate vessels, where movements with millimetric precision impact patient outcomes. Surgeons performing telerobotic procedures need a low-latency connection, with response times under 200 milliseconds to match the brain’s hand-eye coordination. During the Abu Dhabi-to-South Korea procedure, I experienced imperceptible latency while successfully removing a blood clot.
The advent of 5G networks adds another layer to our connectivity needs. While many telesurgeries will likely rely on hard-wired internet connections, 5G’s speed, bandwidth, and wireless capabilities could make telesurgery viable in settings outside traditional hospitals.
To expand patient access and treat stroke patients promptly, we need to bring treatment to them. 5G could play a crucial role in establishing remote care facilities beyond the reach of major hospitals.
Redefined staff roles and protocols
These remote treatment facilities will necessitate reimagining the roles and responsibilities of the care team, a topic on which I co-authored a recent journal publication. The traditional care team includes a main operator, an assistant leading the procedure, and support from a technologist, nurse and an anesthetist.
In a remote scenario, the roles need adjustment. A clinician at the remote facility must be able to manually access the vasculature and perform tasks such as navigating the guiding catheter or placing stents. This individual would need to be an experienced interventionalist.
A revised structure might include an experienced remote robotic operator, a trained robotic technologist, and a supporting interventionalist at the bedside. The on-site team would retain the traditional roles of technologist, nurse, and anesthetist. Additionally, a neurologist specializing in stroke might be needed for remote support, either virtually or in person.
Restructuring the care team is just one of many logistical challenges before remote procedures become commonplace. Regulating remote procedures across borders and oceans presents perhaps the most complex obstacle.
Progressive regulatory measures
The potential benefits of remote procedures for stroke patients are significant, making it crucial to address regulatory challenges.
U.S. states have varying licensing and credentialing standards that can complicate remote imaging for diagnostic purposes.
Internationally, the U.S. healthcare system’s patchwork of public and private insurers could complicate liability and coverage decisions across borders. Countries with single-payer systems, such as the U.K. and Canada, might find it easier to establish regulatory common ground for cross-border procedures.
While data on cost savings for remote procedures is limited, reducing the time to address strokes could potentially lower the costs associated with chronic care following a stroke.
Dr. Vitor Pereira is a neurosurgeon with a dedicated endovascular practice at St. Michael’s Hospital in Toronto, Canada, where he is the director of endovascular research and innovation. He is also a professor of surgery and medical imaging at the University of Toronto.
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The opinions expressed in this blog post are the author’s only and do not necessarily reflect those of Medical Design & Outsourcing or its employees.
