Robotic Telestenting Performance In Transcontinental And Regional Pre-Clinical Models

Objectives This study was conducted to evaluate the association of geographic distance with robotic telestenting performance by comparing performance measures in transcontinental and regional pre-clinical models of telestenting. Background Robotic telestenting, in which percutaneous coronary intervention (PCI) is performed on a remotely located patient, might improve PCI access, but has not been attempted over vast distances likely required to reach many underserved regions. Methods Telestenting performance was compared in regional (Boston to New York [206 miles]) and transcontinental (Boston to San Francisco [3,085 miles]) ex vivo models of telestenting, wherein a physician in Boston attempted robotic PCI on endovascular simulators in New York and San Francisco, respectively. PCI was attempted over both wired and fifth generation (5G)-wireless networks. Outcome measures included procedural success, procedural time, and perceived latency. Results Procedural success was achieved in 20 consecutive target lesions in the regional model and in 16 consecutive target lesions in the transcontinental model. The transcontinental model had a greater latency than the regional model over both wired (121.5 +/- 2.4 ms vs. 67.8 +/- 0.9 ms;p < .001) and 5G-wireless networks (162.5 +/- 1.1 ms vs. 86.6 +/- 0.6 ms;p < .001), but perceived latencies were graded "imperceptible" in all cases in both models. Transcontinental and regional models did not have significantly different procedural times over wired (4.1 +/- 1.9 min vs. 9.0 +/- 7.1 min;p= .051) or 5G-wireless (3.0 +/- 0.6 vs. 6.3 +/- 1.2;p= .36) networks. Conclusions Transcontinental robotic manipulation of coronary devices is now possible and was not associated with adverse performance compared to robotic telestenting conducted regionally.