Initial Clinical Application of a Robotically Steerable Catheter System in Endovascular Aneurysm Repair

Purpose: To report the initial clinical use of a robotically steerable catheter during endovascular aneurysm repair (EVAR) in order to assess this novel and innovative approach in a clinical setting. Technique: Following a series of in-vitro studies and procedure rehearsals using a pulsatile silicon aneurysm model, a 78-year-old man underwent robot-assisted EVAR of a 5.9-cm infrarenal abdominal aortic aneurysm. During the standard procedure, a 14-F remotely steerable robotic catheter was used to successfully navigate through the aneurysm sac, cannulate the contralateral limb of a bifurcated stent-graft under fluoroscopic guidance, and place stiff wires using fine and controlled movements. The procedure was completed successfully. There were no postoperative complications, and computed tomographic angiography prior to discharge and at 3 months confirmed that the stent-graft remained in good position, with no evidence of an endoleak. Conclusion: EVAR using robotically-steerable catheters is feasible. This technology may simplify more complex procedures by increasing the accuracy of vessel cannulation and perhaps reduce procedure times and radiation exposure to the patient and operator.