By the time Jim Smith realized he was having a heart attack, he had only hours to be saved. He’d had chest pains and trouble sleeping for a couple of days but had dismissed his discomfort as acid reflux. His arm ached a little, but he had spent the past few hours laying on his side working on his lawn mower. That night, as his chest began to hurt more and the pain spread to his throat, he knew something was very wrong. Jim’s wife Deb drove him to United Hospital, a small community facility that serves Molcam County in West Michigan. Once inside, Jim began vomiting, and then blacked out. 

Hospital catheterization laboratories (known as cath labs) can perform several types of minimally invasive heart procedures to fix a variety of heart problems. When people suffer cardiovascular emergencies, such as the blocked arteries that cause heart attacks, people need immediate attention. 

But less than half the population in rural America can reach a cath lab within an hour--and that lack of proximity can be deadly. 

“The amount of time that takes place from the moment an artery closes in someone’s heart and they begin having a heart attack, to the moment that artery is opened, determines how well the patient does,” says Dr. Ryan Madder, interventional cardiologist at Spectrum Health in Grand Rapids, Michigan, and the director of their cath lab. “The longer the artery is closed, the more likely the patient is to die from that event. The more damage that gets done to the heart, the more likely the patient is to live with a life of congestive heart failure.” 

When Jim Smith opened his eyes in United Hospital a few minutes later, the doctors gave him alarming news: his heart had stopped, and he had died. Though he had been shocked back to life, he needed help fast. United Hospital didn’t have a cath lab, so he needed to be transferred immediately to a hospital in Grand Rapids to have his artery opened back up. In good weather, the trip would be a 20-minute helicopter ride. But it was raining, so Jim had to make the trip the old fashioned way: the “rough and scary ride” in the back of an ambulance bumping down country roads. It took nearly 40 harrowing minutes, increasing the chances that Jim would have another heart attack on the road. 

When he finally reached Grand Rapids, Jim was admitted to the cath lab, where a cardiologist, nurses, and a radiographer raced to insert a sheath and catheter through his wrist. Through that, they then threaded a wire to deploy miniature balloons and stents to keep the artery open for the long term, heading off future heart attacks. 

In most hospitals in the United States, and around the world, these cardiac catheterization procedures are done manually from the patient’s side, with a cardiologist guiding the catheter through the body by twisting and turning the wire with their hands. But advancements in robotics technology now allow the operator to be in a different room, which reduces their exposure to radiation from the x-ray machine. Catheterization robots, like the Corindus Core GRX, use the same method of twisting and pushing a catheter, but this time it’s driven by a robotic arm, which is controlled by an operator via joystick. 

Because he sees so many patients like Jim Smith who live in remote rural areas of the country, Dr. Madder has been exploring new options. “There’s a concept that if we can use a robot to fix somebody’s heart while sitting a few feet away from them, I think it begs the question why can’t we do it from greater distances?” he says. “The concept of telesurgery involves us taking robotic controls and rather than us having them directly connected via a series of cables to a robotic arm, we connect the two robotic components over a network, and suddenly the distance over which you can fix someone’s heart using a robotic system becomes much larger.”

Dr. Madder and Corindus have completed numerous studies to test the feasibility of physicians using remote robotic systems to fix someone’s arteries. They experimented with connecting the controls to the robot via different networks and from various distances, first from five miles away via a hospital network, then 100 miles away on a public network, and most recently, across the entire United States. Connected via a 5g network, Dr. Madder was able to control a robotic arm in San Francisco from 2,700 miles away in Boston. Amazingly, the vast distance caused no perceptible delay, which is crucial with such a delicate procedure. 

These remote robotic procedures have yet to be approved by the FDA and tested on humans in the United States, though Corindus has successfully completed experiments in India with Dr. Tejas Patel, who put in stents and fixed five blocked human arteries in patients from about 20 miles away.  

Remote robotic surgery is not without risks. “At the moment, there would still need to be a doctor in the operating room in case something went wrong,” says Dr. Madder. “And network security is a large problem to figure out– imagine a hacker connecting to the robot mid-procedure.” 

Despite the challenges, however, the promise of robotic telesurgery is nearly magical. As internet access and connectivity increase around the US and the world, patients living anywhere could get access to cutting-edge healthcare much faster, regardless of whether a doctor is in their town, state, or even country. This represents a paradigmatic shift in access to healthcare, and could save countless lives in rural areas that often suffer from higher rates of cardiac issues to begin with. 

“I hope we can develop this to the point that no patient anywhere in the world has to spend several hours to get their heart fixed when its an emergency situation,” says Dr. Madder, “and that we can develop telerobotics systematically to address the geographical disparities that exist in the United States, and in underdeveloped countries across the world.”

Published on May 24, 2021