Robot-assisted techniques in vascular and endovascular surgery

Abstract

For thousands of years, robots have inspired the imagination of humans, but it was only about 35 years ago that a robot was used for the first time in medicine. Since then, robot-assisted procedures have become increasingly popular in urology, general surgical specialties, and gynecology. Robot-assisted vascular surgery was first introduced in 2002 and was thought to overcome the limitations of laparoscopy. However, it did not gain widespread popularity, and its usage is still limited to a few centers worldwide. Robot-assisted endovascular procedures, on the other hand, while still in its infancy, have become a promising alternative to existing techniques. The improvements of the robotic systems promote better surgical performance and reduce occupational hazards for vascular and endovascular surgeons. A comprehensive review of literature was performed using the search terms “robotic,” “robot assisted,” “vascular surgery,” and “aortic” for surgical procedures or “robotic,” “robot assisted,” and “endovascular” for endovascular procedures. Full text articles that were published between January 1990 and March 2021 were included. This review summarizes the development of the techniques for robot-assisted vascular and endovascular surgery in recent years, its outcomes, advantages, disadvantages, and perspectives.

Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review

“…Since then, two advanced robotic surgical systems have been mainly used in laparoscopic vascular surgery: the da Vinci (Intuitive Surgical Inc, Mountain View, Calif) and Zeus (Computer Motion Inc, Santa Barbara, Calif) systems, which are Leader-Follower robots with similar capabilities (10). The production of the Zeus robot has been discontinued, while in the last decade, the da Vinci robotic surgical telemanipulator has been used for several vascular procedures, that, according to a recent literature review (8), include: robotically assisted repair of abdominal aortic aneurysms (AAA), thromboendarterectomy of the aorta and pelvic artery, iliofemoral and aortofemoral bypass, thoracofemoral bypass from descending thoracic aorta, splenic artery aneurysm, renal artery reconstruction, robotic treatment of type II endoleak after endovascular aneurysm repair, robotic surgery for celiac artery compression syndrome, and robotic-assisted central venous reconstruction.…”

“…However, to date, data from the existing literature are limited to drawing a conclusion regarding the efficacy of robotic technology in vascular surgery (10), given that most studies are mainly limited to individual cases (Stadler's group, which reported on a series of 285 procedures (33), is an exception). At present, robot-assisted vascular surgery has not achieved great popularity and its use is still limited to a few centers worldwide.…”

“…At present, robot-assisted vascular surgery has not achieved great popularity and its use is still limited to a few centers worldwide. According to (10), one possible explanation is that the da Vinci system is not approved for this medical field, moreover, robotic surgery is generally more expensive than conventional procedures and has been associated with longer operating times for many types of procedures. However, with regard to the latter aspect, as pointed out by Soomro et al, most of the existing comparative studies may have been conducted by surgeons who were still learning the robotic technology, and therefore the results may not reflect the potential benefits of this technology (34).…”

“…The Sensei robotic catheter was approved in 2007 by the FDA for use in cardiac mapping and ablative procedures (9), followed by the Magellan system, the first purely vascular robot that received FDA approval in 2012 (10). The Sensei system is equipped with pull-wire steerable sheaths, allowing remote manipulation of catheters via a three-degree-offreedom (3-DOF) joystick, and has been employed successfully in a range of interventions, including cardiac ablation and standard and complex endovascular aneurysm repairs (9).…”

Design and Modeling of a Bio-Inspired Compound Continuum Robot for Minimally Invasive Surgery

“…The ultra-high dexterity makes the continuum robot widely used in various fields of medicine such as laparoscopy and thoracoscopy [5][6][7]. However, with the development of minimally invasive surgery, the requirements for surgical instruments have become stricter.…”