Clinical Feasibility of Robotic-Assisted Endovascular Visceral Interventions

Assessment of the clinical feasibility of robot-assisted endovascular visceral interventions to reduce physical strain caused by prolonged standing and enabling remote interventions.

Between 05/2024 and 09/2024, 45 patients were included in this prospective, single-center study. Patients scheduled for elective endovascular abdominal and pelvic interventions with superselective catheterization were assigned to manual (27 patients) or robotic-assisted treatment (18 patients). Radiation dose of the interventionalist, examination time (including preparation and follow-up), procedure duration and fluoroscopy time were compared between procedures using the CorPath GRX platform (Corindus, Waltham, MA) and conventional procedures. Technical success of robotic interventions was defined as achieving stable microcatheter positioning at the predefined target treatment point in the target vessel under robotic navigation, allowing execution of the planned therapy without conversion to manual navigation.

18 patients underwent robotic-assisted interventions (mean age 68 ± 12 years; 15 male), transarterial chemoembolization (TACE) (n = 9), ^99mTc-MAA simulation (MAA)/transarterial radioembolization (TARE) (n = 2) and prostatic artery embolization (PAE) (n = 7). 27 comparable procedures were performed manually (mean age 68 ± 10 years; 21 male): TACE (n = 13); MAA/TARE (n = 7); PAE (n = 7). 16/18 (88.9%; 95%-CI (Wilson) 67.3-96.7%) robotic-assisted procedures were technically successful, with manual conversion occurring in 2 patients (11.1%; 95%-CI (Wilson) 3.1-32.8%). Neither median fluoroscopy time nor procedural dose, procedure duration or examination time differed between the robotic and conventional interventions [19 min (IQR 19.55) vs. 31 min (IQR 19.85); p = .053; 107.85 Gycm² (IQR 164.03) vs. 128.00 Gycm² (IQR 186.20); p = .286; 65 min (IQR 35.50) vs. 59 min (IQR 49.00); p = .711; 100 min (IQR 37.50) vs. 100 min (IQR 40.00); p = .853]. In comparison with conventional procedures, the operator's dose was lower in robotic interventions [0.000 mSv (IQR 0.000) vs. 0.005 mSv (IQR 0.005); p < .001].

Findings from this pilot case series indicate that robotic-assisted endovascular visceral interventions are feasible and demonstrate a high technical success rate, while simultaneously providing the interventionalist zero radiation exposure through remote operation from the control room.