Robot-Supported Angiography System Advances Hybrid ORs

A novel angiography system offers personalized, minimally invasive surgery for multimorbid patients with changing disease patterns.

The Siemens Healthineers (Erlangen, Germany) Artis pheno provides patients with multiple health issues the option to undergo MIS and interventional radiology and interventional cardiology procedures, despite the additional risks associated with chronic disease. Artis can scan the body up to 15% faster (compared to prior systems Siemens Healthineers systems), and produce three-dimensional (3D) images that need less contrast agent; if the patient is sensitive to the contrast agent, Artis pheno can also support CO2 imaging of the extremities.

The C-arm is 13 centimeters wider and has a free inner diameter of 95.5 centimeters, offering more space for handling adipose patients and longer instrument use that can be used without added difficulty. The multi-tilt table is designed to accommodate patients weighing up to 280 kilograms, with edge of the table capable of tilting to stabilize the patient's blood pressure, for example, or to make breathing easier when necessary. The system can be fitted with a comprehensive range of optional software applications to deal with complex cases.

The robotic construction of the Siemens Healthineers table gives it a flexible isocenter, so that the angiography system can follow all table positions and provide imaging support for the patient's treatment, while representing the target area of the body from virtually any angle. Artis pheno recognizes the position of the tabletop at all times, and automatically aligns itself. Memory positions let the system move the C-arm out of the operating area quickly if necessary, giving the surgeon and team free access to the patient, and then move it back to exactly the same position again for further imaging.

A dedicated hygiene approach combines several factors: an antimicrobial coating prevents bacteria and viruses from multiplying on the system; the wiring is routed inside the system to prevent cables from becoming dirty and potentially transmitting bacteria; and seamless surfaces with no recesses, and spaces that are easy to access, make the system easier to clean. And because the system is floor-mounted, it is easier to install in the OR, and the sterile airflow from the ceiling is interrupted during imaging only by the flat-panel detector.

“We see a high number of multimorbid patients with impaired kidney function in the angio suite,” said Professor Frank Wacker, MD, director of the institute for diagnostic and interventional radiology at Hanover Medical School (Germany). “Shorter scan times help reduce the amount of iodinated contrast agent during 3D angiography in the thorax and abdomen by up to fifteen percent.”

Additional optional application packages include software for extensive spinal fusion procedures using screws or needles; screw paths can be precisely planned, and an automatic path alignment function automatically aligns the C-arm to follow them. A laser integrated in the image detector shows the surgeon the planned path, which helps improve both accuracy and speed in the OR. A number of applications support tumor transarterial chemoembolization (TACE), rendering arterial vessels visible, with graphic overlaying of the selected vessel paths with the real-time X-ray images.

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Siemens Healthineers
Hanover Medical School