After almost three quarters of an hour it’s done, and then even neuroradiologists get the hang of it. “Great!” says one, “awesome!” cheers the other. For the first time in Germany, a patient with a brain aneurysm was treated by a robot-assisted procedure on Wednesday at the Klinikum Rechts der Isar, where the “CorPath GRX Neurovascular” robot celebrated its premiere.
In a few days, the patient will most likely be able to celebrate her 63rd birthday. In early July, she suffered a cerebral hemorrhage from an aneurysm that was treated conventionally. The doctors discovered a second aneurysm – this is a protrusion of a vein in which blood collects. If it bursts or tears it is always life threatening and emergency surgery is required.
In order not to let it get that far in the first place, the patient’s cerebral artery is to be repaired this Wednesday morning. This is done with so-called coils made of platinum wire, which are inserted into the aneurysm. Two things happen as a result: On the one hand, new blood can no longer flow into the bladder. On the other hand, over time, the vessel wall will grow over the aneurysm and thus seal it permanently.
Tobias Boeckh-Behrens and Christian Maegerlein, both doctors in the Department of Diagnostic and Interventional Radiology on the Rechts der Isar, have prepared themselves for the procedure – a silicone model of the affected blood vessels was even made on the 3D printer, on which the physicians could practice.
Elaborate setup: Christian Maegerlein, Senior Physician in the Department of Diagnostic and Interventional Neuroradiology at the University Hospital Rechts der Isar, observes the monitors during the procedure.
(Photo: Kathrin Czoppelt/Klinikum rechts der Isar)
Christian Maegerlein is standing in the room at the operating table, on which the patient is already lying, anesthetized, intubated and covered in sterile clothing all around. Maegerlein is responsible for the approach, so to speak: he is supposed to bring a catheter as close as possible to the aneurysm. It’s done the conventional way – access via a small incision in the groin, from then on the path is so well known that Maegerlein can walk it without x-ray assistance.
The doctor brought the catheter to within about three centimeters of the aneurysm. It now looks on the monitors as if it doesn’t quite match what was seen in the silicone model: the neck, i.e. the connection between the aneurysm and the vessel, seems to be wider than initially assumed. That would be bad, because then there would be a risk that the coils would fall out. However, when Tobias Boeckh-Behrens moves the 3D view back and forth on his monitor, he can give the all-clear: It was just a question of perspective, the neck is as narrow as it should be.
The CorPath GRX Neurovascular robotic arm is now positioned on the operating table. This is of particular interest to two employees from Siemens Healthineers, who sell the device – they came to observe the first use. Inside the first catheter, Boeckh-Behrens pushes a second, narrower one forward using two joysticks on a control board. When the end of the first catheter is reached, things get exciting – the doctor controls a guide wire for the last three centimeters in order to get directly to the entrance of the aneurysm.
A look inside the brain: the progress of the intervention can be constantly observed on the computer monitors.
(Photo: Kathrin Czoppelt/Klinikum rechts der Isar)
This is the most difficult part of the procedure – the micro-catheter must be placed precisely, but of course it must not perforate the vessel wall or penetrate too far into the aneurysm: that would be dangerous for the patient.
It’s as quiet as a mouse now in the operating room and the control cockpit, only now and then Boeckh-Behrens and Maegerlein briefly exchange information about the progress. The advantage of the robot over manual control is now clear: the device allows a feed of less than a millimeter, which would be difficult to do manually, and thus increases accuracy.
Made! The guide wire is pulled out, now the coil should be placed. It is initially straight, six centimeters long. Only in the aneurysm will it roll up into a spiral with a diameter of three millimeters. The small piece of wire costs 800 euros, but that’s not why Tobias Boeckh-Behrens is extremely cautious: Here, too, there is a risk of puncturing the aneurysm. On the monitors in front of the doctor it is very nice to see how the bulge is being filled.
But not enough – another coil is inserted, three centimeters long, then you can see that no more blood flows into the aneurysm – the first operation was successful. And even a neuroradiologist can get a “sucker” from time to time.