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  • Review Article
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Robotic technology in cardiovascular medicine

Nature Reviews Cardiology volume 11, pages 266–275 (2014)Cite this article

Subjects

Key Points

  • The main fields of use of robotic technology in cardiovascular medicine are endoscopic cardiac and vascular surgery, endovascular surgery, catheter-based ablation therapy for atrial fibrillation, and percutaneous coronary intervention

  • Robotic devices enable complex endoscopic reconstructive manoeuvres in narrow spaces and can increase surgical precision; however, robotically assisted totally endoscopic approaches in cardiac and vascular surgery are technically challenging

  • In catheter-based interventions, robotic technology leads to improved catheter stability and reduced radiation exposure to both intervention teams and patients

  • All robotically assisted cardiovascular surgical procedures and catheter-based interventions involve a learning curve, during which conversion rates to conventional techniques and operative times are reduced

  • Prospective, randomized trials to compare robotic and conventional approaches are lacking; observational studies and nonrandomized comparative studies show basic feasibility and safety of robotic interventions and intermediate-term results are promising

Abstract

Robotic technology has been used in cardiovascular medicine since the late 1990s. Interventional cardiology, electrophysiology, endovascular surgery, minimally invasive cardiac surgery, and laparoscopic vascular surgery are all fields of application. Robotic devices enable endoscopic reconstructive surgery in narrow spaces and fast, very precise placement of catheters and devices in catheter-based interventions. In all robotic systems, the operator manipulates the robotic arms from a control station or console. In the field of cardiac surgery, mitral valve repair, CABG surgery, atrial septal defect repair, and myxoma resection can be achieved using robotic technology. Furthermore, vascular surgeons can perform a variety of robotically assisted operations to treat aortic, visceral, and peripheral artery disease. In electrophysiology, ablation procedures for atrial fibrillation can be carried out with robotic support. In the past few years, robotically assisted percutaneous coronary intervention and abdominal aortic endovascular surgery techniques have been developed. The basic feasibility and safety of robotic approaches in cardiovascular medicine has been demonstrated, but learning curves and the high costs associated with this technology have limited its widespread use. Nonetheless, increased procedural speed, accuracy, and reduced exposure to radiation and contrast agent in robotically assisted catheter-based interventions, as well as reduced surgical trauma and shortened patient recovery times after robotic cardiovascular surgery are promising achievements in the field.

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Figure 1: Catheter and sheath during a robotically assisted contralateral gate cannulation for an infrarenal endovascular aneurysm repair.
Figure 2: Robotically assisted totally endoscopic CABG surgery.
Figure 3
Figure 4: Robotic arms docked for robotically assisted laparoscopic abdominal aortic surgery.
Figure 5: Robotic construction of a graft-to-aorta anastomosis in endoscopic abdominal aortic surgery.

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Author information

Authors and Affiliations

  1. Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Sowwah Square, PO Box 112412, Abu Dhabi, United Arab Emirates

    Johannes Bonatti

  2. Pauley Heart Center, Virginia Commonwealth University, Medical College of Virginia, Box 980036, Cardiology Division Room 607 West Hospital, Richmond, 23298-0036, VA, USA

    George Vetrovec

  3. Division of Surgery, Regional Vascular Unit, St Mary's Hospital, Imperial College London, Room 1003, 10th Floor, QEQM Building, Praed Street, London, W2 1NY, UK

    Celia Riga

  4. Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA

    Oussama Wazni

  5. Department of Vascular Surgery, Na Homolce Hospital, Roentgenova 2, Prague 5, 15030, Czech Republic

    Petr Stadler

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All the authors researched data for the article, contributed substantially to the discussion of content, wrote the manuscript, and reviewed/edited the article before submission.

Corresponding author

Correspondence to Johannes Bonatti.

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Competing interests

G.V. is an investigator in the PECISE trial for Corindus Vascular Robotics. C.R. is a consultant for Hansen Medical, and has received educational fees from Gore Medical and Medtronic. The other authors declare no competing interests.

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Bonatti, J., Vetrovec, G., Riga, C. et al. Robotic technology in cardiovascular medicine. Nat Rev Cardiol 11, 266–275 (2014). https://doi.org/10.1038/nrcardio.2014.23

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