How To: Hansen Magellan Robot for Transarterial Chemoembolization

Transcript:
I will be presenting a case of a robot assisted transarterial hepatic chemoembolization.

So, the patient is a 71 year old gentleman with a history of

rapidly progressive gastric cancer, with metastatic disease to the liver. The patient's hepatic disease has been recalcitrant to systemic chemotherapy,

and the patient's most recent CT scan demonstrated disease progression despite both prior hepatic chemoembolization with drug-eluting beads with

Irinotecan as well as systemic chemotherapy. Patient's Eastern Cooperative Oncology Group or ECOG, status was one.

Patient's labs are as shown.

Patient's liver function tests are within normal limits. Of importance, patient had recent repeat biopsy, and molecular testing demonstrated that the

patient's gastric cancer is sensitive to Epirubicin.

This is the patient's CT scan which was performed with contrast. As you can see, there are multiple

masses involving the patient's liver, predominantly within the right hepatic lobe.

The treatment plan in this patient was transarterial hepatic

chemoembolization, and as the patient's disease was sensitive to Epirubicin, we decided to utilize the M1 LC Drug-Eluting beads loaded with Epirubicin,

as prior chemoembolization which was preformed with Irinotecan, Drug-Eluting beads was not effective for the patient's cancer.

The rationale for the

utilization of the Magellan Robotic System was really twofold here. Number one, patient's iliac artery was extremely tortuous, which made stable access

extremely difficult. In addition, rotation of a manual catheter and selection of the celiac axis was extremely challenging. Second, during prior

chemoembolization, both the iliac and the hepatic tortuosity made advancement of a 5 French catheter nearly impossible. Furthermore, microcatheter

advancement distally into branches of the right hepatic artery just was not possible.

These images demonstrate the extreme tortuosity noted in the

patient's right iliac arterial system. There is nearly a 180 degree turn of the right external iliac artery. The third image demonstrates that after

placement of a stiff guidewire and a long sheath, the iliac tortuosity was straightened. However, once the stiff guidewire was removed, the iliac

tortuosity was again apparent and bent the sheath, resulting in problems with manipulation of the manual catheter. The utilization as a 6 French

Magellan Robotic catheter in conjunction with a long sheath allowed for straightening of the robotic system and stable access for subsequent selection

of the celiac artery.

These images demonstrate utilization of the Magellan 6 French robotic catheter, and this catheter allows for extreme flexibility,

allowing for denting of the catheter in any orientation as necessary. And the second video clip here, demonstrates selection of the celiac axis. As is

done with the manual catheter, the catheter is bent downwards, and basically moved downwards until the celiac axis is selected, and then advanced into

the celiac axis.

Once the celiac axis was selected, a celiac angiogram was performed through the 6 French robotic catheter, which shows conventional

anatomy here with the splenic artery, the left gastric artery, and the common hepatic artery.

These images demonstrate the selection of the common

hepatic artery, with the robotic system in conjunction with a 035 guidewire. Initially, the splenic artery was selected but with a small manipulation

of the robotic catheter, the common hepatic artery was then selected. The second video here demonstrates advancement of the 6 French robotic catheter

over the guidewire into the distal common hepatic artery, which was done with relative ease given the excellent stability provided by the robotic

catheter.

Following advancement of the robotic catheter in the common hepatic artery distally, an angiogram was performed which demonstrates gastric

ludinal artery arising distally. What I want to make note of here is that there are two branches of the right hepatic artery as demonstrated here, a

superior branch and an inferior branch, and we were interested in specifically selecting the inferior branch which was supplying a lot of the patients

tumor, which just was not possible during prior chemoembolization as stable access could not be achieved.

In this case, with the utilization of the

robotic catheter...