As a result of the COVID-19 pandemic, health care innovation has been occurring at an unprecedented rate. A growing focus on technology – and the ways that it can help improve patient care and the provider experience – is now at the forefront, and many organizations are reexamining how they can implement new tools and processes in their practices.

In my field of interventional cardiology, one of the innovations that I am most passionate about is robotics. Although the technology has been around for several years, it is crucially important as we start to look toward the future of patient care. I first experienced the benefits of robotic-assisted procedures during my training at the University of Washington. Upon completing my fellowship training, it became a top priority for me to join an organization that either had a robot or was open to implementing a robotics program.

Robotics and automation in current practice

Recently, robotic devices have undergone further developments, and now some robots are even armed with artificial intelligence capabilities. Others have added automated movements that replicate the manual techniques of skilled interventionalists, which can help when navigating tortuous anatomy, crossing tight lesions, and manipulating devices during procedures. Furthermore, these robots allow us to perform procedures with a heightened level of accuracy, reducing the likelihood of a misplaced stent. Like many aspects of interventional cardiology, perfecting the first procedure reduces the chance of a patient requiring subsequent procedures and the associated medical bills. Our margin of error comes down to millimeters and a tiny fraction could make the difference between an effective stent placement and the need for additional stents or a repeat procedure.

In the majority of robotic-assisted cases I perform, automated movements are particularly helpful in delivering gear – I can easily get balloons and stents around the C-shaped curve in the right coronary artery from the cockpit just like I would be able to if I were at the table. In addition to ensuring precision, this means that I’m offered a level of protection from the radiation exposure that interventional cardiologists typically experience. Robotics is one of the many components that can contribute to a radiation safety-based culture, which is a key area of focus for many teams in the interventional space to create safe working conditions and encourage strong teamwork and longevity.

Preparing teams for the future of robotics

Anyone in the field understands the importance of collaboration in the cath lab. However, it’s particularly important when it comes to performing robotic-assisted procedures. Depending on where the interventional workspace is, the physician may not be within speaking distance of the nurses and technicians, so many teams implement strategies – like wearing a headset – to effectively communicate when they’re not in the same room. We always have to be ten steps ahead, thinking about things like additional wiring, imaging, dilation, and more, and we have to know how to create a steady, effective workflow when we’re not all in one space.

While this comes into play in the kind of robotic-assisted scenarios currently performed at hospitals around the world, it is also a key factor in enabling the future of remote robotic procedures. While during current interventions doctors may be a few feet away in the cockpit, in the future, they could be hundreds or thousands of miles away – even in hospitals across the country. In fact, in December 2018, a physician in India performed the first remote, robotic-assisted procedure on a patient from 20 miles away. One of the most important use cases for this capability moving forward is to help patients in remote areas receive treatment, which is currently a major challenge in regions where health care is harder to obtain, or they lack specialized care.

Currently 15% of Americans – 46 million people – who live in rural places are more likely to die of cancer, respiratory diseases, and cardiovascular diseases than those in urban areas. Further highlighting this concern is recent research published in the Journal of the American College of Cardiology that shows patients with acute myocardial infarction were less likely to undergo cardiac catheterization (49.7% versus 63.6%), percutaneous coronary intervention (42.1% versus 45.7%), or coronary artery bypass graft (9.0% versus 10.2%) within 30 days at rural versus urban hospitals.

This disparity can be combated through the implementation of remote, robotic-assisted procedures. For example, suppose there was a robot at a local hospital and a trained operator located at a different organization in a major city. In that case, the physician could perform a remote procedure on the rural patient and ensure that they get the rapid, precise, specialized care they need. As a physician, my top concern is ensuring that as many patients as possible receive the best care they can get, so I’m especially excited about the future of robotics and automation, and the potential to help improve the standard and speed of cardiac care no matter a patient’s location.

Rhian E. Davies is an interventional cardiologist.

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