World's First Fully Automated Robot-Assisted Endovascular Aneurysm Repair Performed

Background

Abdominal aortic aneurysm (AAA) is a condition in which a weakened section of the abdominal aorta bulges outward and risks rupture. Endovascular aneurysm repair (EVAR) is the standard minimally invasive treatment for many suitable patients. During EVAR, stent grafts are inserted through the femoral arteries in the groin and deployed within the aorta under X-ray fluoroscopy to line the vessel and exclude the aneurysmal sac from blood flow.

What was achieved

Professor Lu Qingsheng's team from the Department of Vascular Surgery at Shanghai Changhai Hospital (Naval Medical University) completed the world's first fully automated robot-assisted EVAR procedures. A first-in-human single-center study published in MedComm in 2025 (doi:10.1002/mco2.70489) evaluated the system in four patients with infrarenal abdominal aortic aneurysms.

All four cases achieved 100% technical and clinical success with no major adverse events, device-related complications, or endoleaks on postoperative CTA. Average operative time was 110 ± 47 minutes, fluoroscopy time 19 ± 6 minutes, patient radiation exposure 1251 ± 389 mGy, and surgeon radiation exposure 4 ± 1 mGy. In-vitro testing on 3D-printed models prior to human use demonstrated millimeter-level positioning precision. The work was conducted in collaboration with Aopeng Medical (Shanghai Aopeng Medical Technology Co., Ltd.).

How it works

EVAR requires vascular access via the femoral artery, followed by advancement of guidewires, catheters, and the stent graft through the iliac arteries into the aorta. The stent graft must be accurately positioned relative to key branch vessels and deployed to create a sealed channel that prevents blood from pressurizing the aneurysm sac. Traditional procedures rely heavily on real-time manual control by the operator while exposed to radiation.

The automated system begins with preoperative CT angiography. Imaging software generates a 3D vascular model and extracts parameters such as lengths, angles, and deployment positions. These are converted into programmed surgical instructions. The endovascular robot then autonomously executes key steps—guidewire navigation, stent delivery, precise positioning, and release—without manual intervention during critical phases. The system is compatible with commercially available devices, incorporates multiple safety mechanisms, and allows surgeon oversight from a shielded control area. This parameterized approach aims to reduce operator variability while maintaining efficiency and safety.

What it means for international patients

The study indicates progress in robotic vascular surgery toward greater standardization, reduced radiation exposure for operators, and decreased dependence on individual operator experience. Shanghai Changhai Hospital treats foreign nationals, who can register using a passport. Third-party medical concierge services report assisting international patients seeking vascular and other specialty care with coordination, interpretation, and logistics.

Patients considering care at the hospital for robotic-assisted EVAR or related vascular procedures should contact the hospital directly to confirm current availability, individual eligibility, and any support services. Suitability depends on specific anatomy, medical history, and clinical assessment by the hospital team.

About the hospital

Changhai Hospital, also known as the First Affiliated Hospital of Naval Medical University, is located at 168 Changhai Road, Yangpu District, Shanghai. Founded in 1949, it is a large Grade A tertiary (3A) general teaching hospital with more than 2,100 beds and approximately 3.6 million outpatient and emergency visits annually. It integrates medical care, teaching, and research.

The hospital is recognized for strengths in major vascular surgery (a national key discipline), burn and trauma care, digestive system diseases, urinary system diseases, cardiovascular and cerebrovascular diseases, and integrated traditional Chinese and Western medicine for tumors. Its clinical medicine ranks in the top 0.1% globally by ESI indicators. The official website is www.chhospital.com.cn.