Evaluating the use of robotically assisted percutaneous coronary intervention: a matter of being precise

Since the advent of catheter-based coronary intervention three decades ago, steady technological progress has led to the development and refinement of intracoronary devices [1]. Despite technological advances, the fundamental workflow of coronary procedures remains unchanged. Interventionalists still wear heavy protective lead aprons, stand at the bedside for long hours and manually manipulate catheters and intra vascular devices under direct fluoroscopic guidance. As the field has matured, greater attention has been paid to the long-term occupational hazards of this antiquated interventional approach [2]. A striking prevalence of orthopedic injuries and spinal disc disease has been reported following hours of standing under heavy lead aprons [3,4]. Although radiation badges worn by inter ventional personnel can help track and limit exposure, any radiation exposure may be harmful, and risks of solid or hematologic malignancy continue to be a significant concern [5,6]. A high prevalence of posterior lens radiation injuries leads to earlier cataracts among interventionalists and provides additional incentive to minimize ionizing radiation exposure [7]. Given the clear risks of modern practice, remotecontrol robotic catheter-based systems were first proposed to mitigate occupational hazards in percutaneous coronary interventions (PCIs). Beyar et al. developed the first-generation ‘Remote Navigation System’ for PCI (Remote Navigation System, NaviCath, Haifa, Israel), consisting of a joystick controlled operator module and motorized drive to advance and retrieve intravascular devices mounted on the procedure table. A small clinical pilot study demonstrated the feasibility and safety of this robotic system for single-vessel PCI [8,9]. Following this early study, the Robotic Navigation System was redesigned as the CorPath System (Corindus Vascular Robotics, MA, USA).