Robotic-Assisted Percutaneous Coronary Intervention: Rationale, Implementation, Case Selection and Limitations of Current Technology

Interventional cardiologists have witnessed an explosive growth in the field. A wide array of percutaneous procedures allow us to treat numerous cardiac conditions less invasively. However, the way we work has changed very little over the past decades. We continue to stand at the tableside for prolonged periods of time, exposing ourselves to the very real risks of radiation exposure as well as to the associated orthopedic injuries from radiation protection. The precision of our procedures is limited by the distance from the fluoroscopic images and, furthermore, patients are potentially at risk from operator fatigue caused by a physician standing at the table for prolonged periods while wearing cumbersome radiation protection gear. Robotic-assisted coronary intervention removes the operator from the radiation field and has been shown to markedly reduce operator exposure as well as allow for more precise positioning of balloons and stents. This technology holds great promise for making interventional procedures safer and more comfortable for the operators as well as reducing fatigue, potentially improving patient outcomes. Currently, we are in an ‘early adopter’ phase of this technology and this paper reviews the rationale, methodology, optimal case selection, and limitations of robotic-assisted coronary intervention.