Endovascular surgical robots have advanced vascular surgery through the integration of automatic programs for complex interventions. However, current systems still lack full procedural automation capabilities. This single-center single-arm study explores the feasibility and safety of automatic robotic-assisted endovascular aortic repair (EVAR) using a novel surgical algorithm with in vitro and in vivo experiments. The EVAR process was deconstructed into surgical steps and programmed into an endovascular surgical robot, which executed the steps automatically based on parameters derived from image processing software. In vitro experiments using 3D-printed vascular models demonstrated millimeter-level precision, with reduced operation time, fluoroscopy time, and radiation exposure compared to manual robotic control. In vivo evaluations in four patients with abdominal aortic aneurysms achieved 100% technical and clinical success, with no major adverse events. Operation time averaged 110 ± 47 min, fluoroscopy time was 19 ± 6 min, and patient-side radiation exposure was 1251 ± 389 mGy. Surgeon-side radiation exposure was 4 ± 1 mGy. The results indicate that automatic robotic-assisted EVAR can be performed with acceptable accuracy and safety to provide standardized therapies, shorten operation time, and reduce radiation exposure of patients.
| [1] |
S. Ernst, F. Ouyang, C. Linder, et al., “Initial Experience With Remote Catheter Ablation Using a Novel Magnetic Navigation System: Magnetic Remote Catheter Ablation,” Circulation 109, no. 12 (2004): 1472–1475.
|
| [2] |
R. Beyar, L. Gruberg, D. Deleanu, et al., “Remote-Control Percutaneous Coronary Interventions: Concept, Validation, and First-in-Humans Pilot Clinical Trial,” Journal of American College of Cardiology 47, no. 2 (2006): 296–300.
|
| [3] |
G. Weisz, D. C. Metzger, R. P. Caputo, et al., “Safety and Feasibility of Robotic Percutaneous Coronary Intervention: PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention) Study,” JACC 61, no. 15 (2013): 1596–1600.
|
| [4] |
J. F. Granada, J. A. Delgado, M. P. Uribe, et al., “First-in-Human Evaluation of a Novel Robotic-Assisted Coronary Angioplasty System,” JACC Cardiovascular Interventions 4, no. 4 (2011): 460–465.
|
| [5] |
C. C. Smitson, L. Ang, A. Pourdjabbar, R. Reeves, M. Patel, and E. Mahmud, “Safety and Feasibility of a Novel, Second-Generation Robotic-Assisted System for Percutaneous Coronary Intervention: First-in-Human Report,” Journal of Invasive Cardiology 30, no. 4 (2018): 152–156.
|
| [6] |
E. Mahmud, F. Schmid, P. Kalmar, et al., “Feasibility and Safety of Robotic Peripheral Vascular Interventions: Results of the RAPID Trial,” JACC Cardiovascular Interventions 9, no. 19 (2016): 2058–2064.
|
| [7] |
W. Guo, C. Song, J. Bao, et al., “A Novel Endovascular Robotic System for Treatment of Lower Extremity Peripheral Arterial Disease: First-in-Human Experience,” Journal of Endovascular Therapy 32, no. 1 (2025): 18–28.
|
| [8] |
Q. Lu, Y. Shen, S. Xia, B. Chen, and K. Wang, “A Novel Universal Endovascular Robot for Peripheral Arterial Stent-Assisted Angioplasty: Initial Experimental Results,” Vascular and Endovascular Surgery 54, no. 7 (2020): 598–604.
|
| [9] |
V. Mendes Pereira, N. M. Cancelliere, P. Nicholson, et al., “First-in-human, Robotic-Assisted Neuroendovascular Intervention,” Journal of NeuroInterventional Surgery 12, no. 4 (2020): 338–340.
|
| [10] |
R. G. Nogueira, R. Sachdeva, A. R. Al-Bayati, M. H. Mohammaden, M. R. Frankel, and D. C. Haussen, “Robotic Assisted Carotid Artery Stenting for the Treatment of Symptomatic Carotid Disease: Technical Feasibility and Preliminary Results,” Journal of NeuroInterventional Surgery 12, no. 4 (2020): 341–344.
|
| [11] |
K. C. Sajja, A. Sweid, F. Al Saiegh, et al., “Endovascular Robotic: Feasibility and Proof of Principle for Diagnostic Cerebral Angiography and Carotid Artery Stenting,” Journal of NeuroInterventional Surgery 12, no. 4 (2020): 345–349.
|
| [12] |
C. Lyu, S. Guo, Y. Yan, et al., “Flexible Tactile-Sensing Gripper Design and Excessive Force Protection Function for Endovascular Surgery Robots,” IEEE Robotics and Automation Letters 8, no. 10 (2023): 6171–6178.
|
| [13] |
P. Fiorini, K. Y. Goldberg, Y. Liu, and R. H. Taylor, “Concepts and Trends in Autonomy for Robot-Assisted Surgery,” Proceedings of the Institute of Electrical and Electronics Engineers 110, no. 7 (2022): 993–1011.
|
| [14] |
A. J. Meltzer, P. H. Connolly, D. B. Schneider, and A. Sedrakyan, “Impact of Surgeon and Hospital Experience on Outcomes of Abdominal Aortic Aneurysm Repair in New York State,” Journal of Vascular Surgery 66, no. 3 (2017): 728–734. e722.
|
| [15] |
W. Duan, T. Akinyemi, W. Du, et al., “Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review,” Micromachines (Basel) 14, no. 1 (2023): 197.
|
| [16] |
N. M. Alekseeva, A. G. Viller, and A. M. Romanov, “A Unified Algorithm for Robotic-Assisted Cardiac Endovascular Surgery,” In: 2024 IEEE Ural-Siberian Conference on Biomedical Engineering, Radioelectronics and Information Technology (USBEREIT). 2024:31–35.
|
| [17] |
C. Riga, C. Bicknell, N. Cheshire, and M. Hamady, “Initial Clinical Application of a Robotically Steerable Catheter System in Endovascular Aneurysm Repair,” Journal of Endovascular Therapy 16, no. 2 (2009): 149–153.
|
| [18] |
C. V. Riga, C. D. Bicknell, A. Rolls, N. J. Cheshire, and M. S. Hamady, “Robot-Assisted Fenestrated Endovascular Aneurysm Repair (FEVAR) Using the Magellan System,” Journal of Vascular and Interventional Radiology 24 (2013): 191–196.
|
| [19] |
A. Al Nooryani and W. Aboushokka, “Rotate-on-Retract Procedural Automation for Robotic-Assisted Percutaneous Coronary Intervention: First Clinical Experience,” Case Reports in Cardiology 2018 (2018): 6086034.
|
| [20] |
C. Song, S. B. Xia, L. Zhang, et al., “A Novel Endovascular Robotic-assisted System for Endovascular Aortic Repair: First-in-Human Evaluation of Practicability and Safety,” European Radiology 33, no. 11 (2023): 7408–7418.
|
| [21] |
C. Song, S. Xia, H. Zhang, et al., “Novel Endovascular Interventional Surgical Robotic System Based on Biomimetic Manipulation,” Micromachines 13, no. 10 (2022): 1587.
|
| [22] |
K. D. Wang, Q. S. Lu, B. Chen, et al., “Endovascular Intervention Robot With Multi-manipulators for Surgical Procedures: Dexterity, Adaptability, and Practicability,” Robotics and Computer-Integrated Manufacturing 56 (2019): 75–84.
|
| [23] |
K. Wang, X. Mai, H. Xu, Q. Lu, and W. Yan, “A Novel SEA-based Haptic Force Feedback Master Hand Controller for Robotic Endovascular Intervention System,” International Journal of Medical Robotics 16, no. 5 (2020): 1–10.
|
| [24] |
C. Noble, Experimental and Numerical Techniques for Characterising Catheter-Induced Blood Vessel Damage: Towards Tools for Improvement of Intravascular Catheter Design (Ph.D. University of Sheffield, 2016), https://etheses.whiterose.ac.uk/17418/.
|
| [25] |
R. Ruggiero, A. A. Khokhar, Z. Siudak, A. Zlahoda-Huzior, A. Zelias, and D. Dudek, “Evaluation of the CorPath-GRX TechnIQ Automated Movements During Robotic-PCI (NAVIGATE GRX study),” Cardiovascular Revascularization Medicine (2025).
|
| [26] |
K. Wang, B. Chen, Q. Lu, et al., “Design and Performance Evaluation of Real-Time Endovascular Interventional Surgical Robotic System With High Accuracy,” International Journal of Medical Robotics 14, no. 5 (2018): e1915.
|
| [27] |
E. Mahmud, J. Naghi, L. Ang, et al., “Demonstration of the Safety and Feasibility of Robotically Assisted Percutaneous Coronary Intervention in Complex Coronary Lesions: Results of the CORA-PCI Study (Complex Robotically Assisted Percutaneous Coronary Intervention),” JACC Cardiovascular Interventions 10, no. 13 (2017): 1320–1327.
|
| [28] |
B. Bay, L. M. Kiwus, A. Goßling, et al., “Procedural and One-year Outcomes of Robotic-Assisted Versus Manual Percutaneous Coronary Intervention,” EuroIntervention 20, no. 1 (2024): 56–65.
|
| [29] |
M. J. Connor, P. Dasgupta, H. U. Ahmed, and A. Raza, “Autonomous Surgery in the Era of Robotic Urology: Friend or Foe of the Future Surgeon?,” Nature Reviews Urology 17, no. 11 (2020): 643–649.
|
| [30] |
W. R. Hendee and F. M. Edwards, “ALARA and an Integrated Approach to Radiation Protection,” Seminars in Nuclear Medicine 16, no. 2 (1986): 142–150.
|
| [31] |
M. Gurgitano, S. A. Angileri, G. M. Rodà, et al., “Interventional Radiology Ex-Machina: Impact of Artificial Intelligence on Practice,” Radiologia Medica 126, no. 7 (2021): 998–1006.
|
| [32] |
L. Karstensen, J. Ritter, J. Hatzl, et al., “Recurrent Neural Networks for Generalization Towards the Vessel Geometry in Autonomous Endovascular Guidewire Navigation in the Aortic Arch,” International Journal of Computer Assisted Radiology and Surgery 18, no. 9 (2023): 1735–1744.
|
| [33] |
H. S. Song, B. J. Yi, J. Y. Won, and J. Woo, “Learning-Based Catheter and Guidewire-Driven Autonomous Vascular Intervention Robotic System for Reduced Repulsive Force,” Journal of Computational Design and Engineering 9, no. 5 (2022): 1549–1564.
|
| [34] |
E. L. Chaikof, J. D. Blankensteijn, P. L. Harris, et al., “Reporting Standards for Endovascular Aortic Aneurysm Repair,” Journal of Vascular Surgery 35, no. 5 (2002): 1048–1060.
|
RIGHTS & PERMISSIONS
2025 The Author(s). MedComm published by Sichuan International Medical Exchange & Promotion Association (SCIMEA) and John Wiley & Sons Australia, Ltd.
PDF
