Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review

Abstract

Prior methods of patient care have changed in recent years due to the availability of minimally invasive surgical platforms for endovascular interventions. These platforms have demonstrated the ability to improve patients’ vascular intervention outcomes, and global morbidities and mortalities from vascular disease are decreasing. Nonetheless, there are still concerns about the long-term effects of exposing interventionalists and patients to the operational hazards in the cath lab, and the perioperative risks that patients undergo. For these reasons, robot-assisted vascular interventions were developed to provide interventionalists with the ability to perform minimally invasive procedures with improved surgical workflow. We conducted a thorough literature search and presented a review of 130 studies published within the last 20 years that focused on robot-assisted endovascular interventions and are closely related to the current gains and obstacles of vascular interventional robots published up to 2022. We assessed both the research-based prototypes and commercial products, with an emphasis on their technical characteristics and application domains. Furthermore, we outlined how the robotic platforms enhanced both surgeons’ and patients’ perioperative experiences of robot-assisted vascular interventions. Finally, we summarized our findings and proposed three key milestones that could improve the development of the next-generation vascular interventional robots.

Safety and feasibility study of a novel robotic system in an in vivo porcine vascular model

“…However, while using such a device, the absence of force feedback and haptic perception, which leads one to speculate that it may have the potential to lead to unintentional vascular injuries, if these procedures were performed in a larger study population. Nonetheless, a considerable reduction in risk may result from upgrades in systems for collision detection and the improvements of force sensor systems may also assist to mitigate these dangers [ 7 ]. According to this initial experience, the specific robotic system demonstrated a shallow learning curve for untrained operators, as demonstrated by the technical success rate and the short catheterization times by both operators.…”

“…Additionally, the size and weight of the system enables easy transportation and provides ergonomic advantages that make it suitable for every standard angiography suite. Another advantage is its compatibility with standard off-the-shelf instruments and although this is a common feature with the Robocath R-One robot system, the latter is substantially larger and more expensive than the former [ 7 ]. Another essential feature of the robotic system is the capacity to transition to human control rapidly, thus increasing its safety profile.…”

“…Since the principal radiation protection measures and shielding used during endovascular interventions performed in the angiography suite are mostly operator-dependent [ 5 , 6 ], the inclusion of a joystick-operated robotic device is a protective factor, as interventionalists will be able to operate from a safe distance in regard to the exposure of dispersed radiation. In comparison to merely skilled human performance, robotic systems have the advantage to assist navigation accuracy, dexterity, and speed [ 7 ] When it comes to delivering devices and manipulating catheters during robotic-assisted endovascular procedures, the early generation of devices required dedicated catheters (robotic catheters) and high-profile sheaths, which limit the practicality and increases the cost of consumables, especially in more complicated procedures [ 8 , 9 ]. Newer generation vascular system technologies have undergone further technological development making possible to use off-the-shelf products, which makes them more appealing and accessible, laying the groundwork for the establishment of telemedicine and telementoring programs.…”

Continuum Robots and Magnetic Soft Robots: From Models to Interdisciplinary Challenges for Medical Applications

“…In the application sphere, continuum robots, due to their exceptional flexibility and adaptability, find widespread use in medical, disaster relief, and deep-sea exploration fields. Magnetic soft robots, conversely, excel in precise control aspects like catheter intervention [ 84 ] and targeted drug delivery [ 85 ]. Technologically, continuum robots primarily depend on intricate mechanical structures and power systems, such as tendon or rod actuation, posing significant manufacturing challenges at sub-millimeter scales.…”

Cosserat Rod-Based Dynamic Modeling of a Hybrid-Actuated Soft Robot for Robot-Assisted Cardiac Ablation

“…Figure 1 illustrates the configuration of a hybrid-actuated soft robot functioning as a catheter within a patient's heart during RFA ablation. Robot-assisted catheter intervention (RCI) represents state-of-the-art technology used to treat cardiac abnormalities [6,7]. The introduction of robotic catheterization aimed to mitigate the risks associated with traditional manual intervention methods [8,9].…”