Intraoperative Vascular Imaging and Robotics: How Operating Rooms Will Look in the Near Future

Describing the appearance of the operating room of the future is challenging due to the rapid developments in both imaging and robotics. As described elsewhere in this journal, both rigid (Intuitive) and flexible (Hansen) robotics promise to fundamentally alter the way we deliver therapy within body cavities and blood vessels. In this manuscript, we describe yet another application of robotics in cardiovascular therapy, namely the development of robotics angiographic imaging systems.

The vascular bed is a dynamic one and thus, not including motion, could allow for misinterpretation. Therefore, imaging must include four aspects in order to be of great promise in the endovascular arena: 1) the equipment must have adequate definition and thereby be able to characterize tissues and define boundaries between anatomic structures; 2) the system must be interactive and intuitive; 3) three-dimensional capabilities are necessary when navigating vascular anatomy; and 4) it must include a fourth dimension, the ability to evaluate motion.

The ideal operating room would be able to incorporate all these features into a flat panel, high-definition system that can be controlled from a common user interface. Furthermore, since post-imaging analysis is commonplace, it is imperative that all imaging be saved in the same format. The most common and exploitable format is Digital Imaging and Communications in Medicine (DICOM).

The Siemens Zeego angiographic imaging system is a completely new concept in angiographic imaging (Figure 1), replacing traditional C-arms with robotic, highly articulated C-arrns modeled around car assembly line robots. There are numerous advantages for such a system: it optimizes space efficiency in equipment-laden hybrid rooms, it allows for rapid repositioning for total body imaging, and the speed of camera movement optimizes image quality. The capability of these C-arms to rapidly acquire a fluoro CT (or DynaCT) image will revolutionize catheter and device navigation (Figure 2).