Human versus machine: are neurointerventionists more precise in manual or robotically assisted procedures?

Background: Robotic neurointerventions have demonstrated promising initial clinical results. Claims of enhanced precision during robotic navigation have been reported, but objective quantification of such precision is limited. Precision during intracranial navigation and device deployment is crucial in neurovascular interventions, and lack of precision can lead to intraprocedural complications. This study compared quantitative metrics of precision in manual and robotic procedures using a virtual simulator.

Methods: Using three different simulated aneurysm procedures with different levels of difficulty (easy, medium, and hard), 12 operators with different levels of experience were assigned a defined task for each case. Each procedure was performed both manually and under robotic assistance. Precision was assessed using the length of translations and the total degree of rotations of the microwire and microcatheter needed to complete the assigned tasks, as well as recorded safety metrics. Results were compared between the manual and robotic groups.

Results: We analyzed 78 procedures (robotic, n=34; manual, n=34) performed by 12 operators with various levels of neurointerventional surgical experience (high, n=5; low, n=7). For the difficult case, operators used significantly less microwire translations when operating with robotic assistance (38.7 cm vs 108.4 cm, P=0.023). There were no significant differences for the easy and medium cases. Safety metrics and procedural times were not significant different.

Conclusions: Operators demonstrated increased precision during microwire navigation when using robotic assistance to navigate a difficult aneurysm in a controlled simulated experimental set-up compared with manual navigation.