Feasibility of robotic neuroendovascular surgery

Abstract

Background: Several recent reports of CorPath GRX vascular robot (Cordinus Vascular Robotics, Natick, MA) use intracranially suggest feasibility of neuroendovascular application. Further use and development is likely. During this progression it is important to understand endovascular robot feasibility principles established in cardiac and peripheral vascular literature which enabled extension intracranially. Identification and discussion of robotic proof of concept principals from sister disciplines may help guide safe and accountable neuroendovascular application.

Objective: Summarize endovascular robotic feasibility principals established in cardiac and peripheral vascular literature relevant to neuroendovascular application.

Methods: Searches of PubMed, Scopus and Google Scholar were conducted under PRISMA guidelines¹ using MeSH search terms. Abstracts were uploaded to Covidence citation review (Covidence, Melbourne, AUS) using RIS format. Pertinent articles underwent full text review and findings are presented in narrative and tabular format.

Results: Search terms generated 1642 articles; 177, 265 and 1200 results for PubMed, Scopus and Google Scholar respectively. With duplicates removed, title review identified 176 abstracts. 55 articles were included, 45 from primary review and 10 identified during literature review. As it pertained to endovascular robotic feasibility proof of concept 12 cardiac, 3 peripheral vascular and 5 neuroendovascular studies were identified.

Conclusions: Cardiac and peripheral vascular literature established endovascular robot feasibility and efficacy with equivalent to superior outcomes after short learning curves while reducing radiation exposure >95% for the primary operator. Limitations of cost, lack of haptic integration and coaxial system control continue, but as it stands neuroendovascular robotic implementation is worth continued investigation.

Keywords: Endovascular; neuroendovascular; neurointervention; robot; telerobotic; telestroke; telesurgery.

Figure 1.

(a) CorPathGRX tableside drive arm and cassette holder (b) CorPathGRX robotic cassette on drive arm ready for loading (c) CorPathGRX remote console operated from control room (d) CorPathGRX joy-stick/touch screen interface i) turbo button for increased movement speed ii) catheter axial control iii) catheter rotational control iv) wire axial and rotational control.