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Review
Robotics in neurointerventional surgery: a systematic review of the literature
  1. William Crinnion1,2,
  2. Ben Jackson1,
  3. Avnish Sood1,
  4. Jeremy Lynch3,
  5. Christos Bergeles1,
  6. Hongbin Liu1,
  7. Kawal Rhode1,
  8. Vitor Mendes Pereira4,
  9. Thomas Calvert Booth1,3
  1. 1School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
  2. 2NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
  3. 3Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
  4. 4Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to William Crinnion, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; willcrinnion{at}gmail.com

Abstract

Background Robotically performed neurointerventional surgery has the potential to reduce occupational hazards to staff, perform intervention with greater precision, and could be a viable solution for teleoperated neurointerventional procedures.

Objective To determine the indication, robotic systems used, efficacy, safety, and the degree of manual assistance required for robotically performed neurointervention.

Methods We conducted a systematic review of the literature up to, and including, articles published on April 12, 2021. Medline, PubMed, Embase, and Cochrane register databases were searched using medical subject heading terms to identify reports of robotically performed neurointervention, including diagnostic cerebral angiography and carotid artery intervention.

Results A total of 8 articles treating 81 patients were included. Only one case report used a robotic system for intracranial intervention, the remaining indications being cerebral angiography and carotid artery intervention. Only one study performed a comparison of robotic and manual procedures. Across all studies, the technical success rate was 96% and the clinical success rate was 100%. All cases required a degree of manual assistance. No studies had clearly defined patient selection criteria, reference standards, or index tests, preventing meaningful statistical analysis.

Conclusions Given the clinical success, it is plausible that robotically performed neurointerventional procedures will eventually benefit patients and reduce occupational hazards for staff; however, there is no high-level efficacy and safety evidence to support this assertion. Limitations of current robotic systems and the challenges that must be overcome to realize the potential for remote teleoperated neurointervention require further investigation.

  • device
  • technology

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Footnotes

  • Twitter @VitorMendesPer1

  • Contributors WC: manuscript preparation, review, editing. BJ, AS, CB, HL, KR and TCB: review, editing. JL, VMP – review, editing, video editing.

  • Funding This work was supported by the NIHR Guy’s and St Thomas Biomedical Research Centre and the Wellcome/Engineering and Physical Sciences Research Council Centre for Medical Engineering (WT 203148/Z/16/Z).

  • Competing interests VMP has acted as a consultant for Corindus and is an investigator in the Corpath GRX Neuro Study. The remaining authors have no conflicts of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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