How close are robotics to deployment for endovascular treatment? In this interview, champion for robotics Barry Katzen (Baptist Health South Florida, Coral Gables, USA) discusses the developments of the past year and the current conversation surrounding the tangible integration of robotic systems within interventional suites.
What have been the most important advances in endovascular robotics over the last year?
There have been several advances in endovascular robotics over the last year—some in the public domain and some of them not public. The advances that have been made in technology development have involved multiple companies who are currently pursuing robotics, which is very exciting. Several companies have announced first-in-human cases with this advanced technology, such as the Sentante fully robotic tele-operated system for various peripheral interventions such as balloon angioplasty and stent delivery. In Korea, Navigantis announced the first successful neurovascular cases performed with its Vasco interventional robotic platform to treat patients with neurovascular disorders.
We have seen some commercialisation of disposable robots this year too, and, with US Food and Drug Administration (FDA) approvals, these could be used to help interventionalists perform microvascular catheterisation. There has also been early-stage usage of remote robotic stroke therapy performed through simulations; so, a lot has been happening in the past year.
What unmet clinical need are endovascular robotics best positioned to solve in 2026?
The principal focus for robotics has centred on remote stroke therapy and being able to develop the resources necessary to bring this to the mainstream, but I’m not sure we have identified the key to this yet.
In the USA, there are around 5,000 hospitals, and only a small fraction of those are comprehensive stroke centres, so there is a manpower limitation to providing acute clot extraction and stroke therapy. What robotic therapy offers is the opportunity for somebody in a smaller, rural hospital—that can afford an angiographic suite to facilitate stroke therapy but can’t afford a full-time neurointerventionist—to offer this treatment. The potential is to deliver stroke therapy in many more places, closer to where the patient is, for centres that aren’t currently able to offer this service. That potential is what’s attracting a huge amount of venture capital and research to see whether this is feasible or not.
The use of robotics in stroke therapy also raises the question: is the endgame of these efforts robotic usage or automation via robotics? In the same way as with self-driving cars, are we seeking a technology that can be controlled by a clinician, or should we be looking at automation, where you can take all the data and imaging and treat the patient this way? If successful, particularly for remote stroke therapy, you might be able to have clinicians with less dedicated skills and training treat many more patients.
In your view, are endovascular robotics primarily a precision, radiation-reduction or workflow streamlining tool?
These are all advantages and opportunities in endovascular robotics, but I think it remains to be proven. When we look at the causes of commercial failure of these systems, one of the biggest causes was lack of proof of value and lack of doing the clinical science around answering those important questions.
Mostly, robotic development has been around reaching a regulatory milestone, then moving into the commercialisation space and letting the market decide where the value is. I believe that strategy is going to continue to be a loser from a commercialisation point of view. It’s important that we—meaning clinicians and the marketplace— emphasise to developers that we must show proof of value, whether it’s radiation or time reduction, or precision.
In the USA, radiation reduction has been talked about much more of late and I believe this has major advantages for all operators, but the interesting question is whether robotics can reduce radiation for the patient. In theory, if it is proven that robotic control of catheters, for example, is more efficient than a human operator, this may mean reduced radiation exposure for the patient.
Could robotics help standardise complex endovascular procedures across operators and centres?
Robotics can definitely democratise endovascular skills and narrow the difference between novice and experienced operators. It’s an exciting potential benefit of robotics. It could make tasks easier for experienced operators. So, I think there’s a clear advantage to accelerating the ability to accomplish complicated tasks.
If you were advising a young interventalionist today, how seriously should they be preparing for a robotic future?
If you’re a young interventalionist today, you should be paying attention to what’s going on in robotics, and, to whatever extent possible, get engaged in the research that’s going to be necessary to prove their benefit.
The cost of robotic therapies represents a significant barrier to adoption and dissemination, and that’s one of the reasons this research must be done to validate its value.
The future of robotics may also influence the design of the interventional suite or hybrid operating room (OR), which could be a very important factor for young interventionalists to be aware of. We are beginning to discuss whether we should be making plans for robotic implementation when designing new ORs. Putting suites together can be a very expensive proposition and many of these robotic devices have a very significant footprint, e.g. power and space needs. I do believe that the potential installation of robotic systems should be included in the planning of these suites so
