Robotics for neuroendovascular intervention: Background and primer

Abstract

The simultaneous growth of robotic-assisted surgery and telemedicine in recent years has only been accelerated by the recent coronavirus disease 2019 pandemic. Robotic assistance for neurovascular intervention has garnered significant interest due to opportunities for tele-stroke models of care for remote underserved areas. Lessons learned from medical robots in interventional cardiology and neurosurgery have contributed to incremental but vital advances in medical robotics despite important limitations. In this article, we discuss robot types and their clinical justification and ethics, as well as a general overview on available robots in thoracic/abdominal surgery, neurosurgery, and cardiac electrophysiology. We conclude with current clinical research in neuroendovascular intervention and a perspective on future directions.

Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings

“…4. Tele-interventional services: While this might be a more futuristic application, studies exploring remote procedures, e.g., thrombectomy via telemedicine, highlight the potential for advanced interventions without requiring physical presence 127…”

Neuroendovascular robotics: wave of the future or failed promise?

“…Furthermore, most robotic systems lack haptic feedback and, finally, the costs of robots are often prohibitive. 4 The first use of a surgical robot was in 1985 with a modified industrial robotic arm in a stereotactic brain biopsy. In the late 1990s the daVinci surgical system (Intuitive Surgical, Sunnyvale, California, USA) emerged and has been subsequently FDA cleared for multiple surgical fields with widespread use.…”

“…Expanding indications for stroke thrombectomy and the holes in geographic stroke coverage pushed this envelope even further. 4 A wide range of varying NVI cases has subsequently been performed with the GRX system including diagnostic angiography with a variety of catheters, carotid artery stenting, and aneurysm coiling. 6 The most extensive report detailed GRX-assisted aneurysm coiling in 117 patients with encouraging results.…”

“…Even digging past the superficial details of the GRX, Corindus developed multiple novel algorithms to enhance the device navigation to expand on its core automatic movement features. 4 So, are the cynics correct? Is robotics a dead horse in NVI?…”