Stuart James Corr

This 55-minute webcast features a conversation about “Vascular Robotics”—the focus of Issue 21.5. Led by the issue’s editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/5556427.

The field of vascular intervention is entering a new era defined by the convergence of robotics, advanced imaging, and artificial intelligence (AI)-a paradigm increasingly referred to as "intelligent surgery." In this context, robotics provides precision and dexterity, imaging supplies dynamic anatomical and physiological insight, and data-driven analytics offer predictive and adaptive guidance. Together, these technologies are reshaping the practice of vascular surgery and interventional medicine, enabling procedures that are safer, more efficient, and more personalized than ever before. This unique edition on vascular robotics in the era of intelligent surgery brings together a diverse set of contributions that highlight both the current state of the art and the trajectory of innovation in this space. Articles in this issue explore intraoperative data analytics and the concept of smart surgical suites, underscoring the growing importance of integrated, real-time decision-support systems. They also reveal the evolving role of robotic systems in cardiovascular interventions as well as the clinical application and technical skill assessment of robotic-assisted vascular procedures. Complementing these perspectives are reviews on remote and telerobotic ultrasound imaging, innovations in MRI and AI for peripheral artery disease, and a forward-thinking overview into the fusion of robotics with imaging modalities for enhanced surgical guidance. We begin this exploration with a review Alan Lumsden and I have authored with our colleagues titled "From Data to Decision: A Comprehensive Review of Real-Time Analytics and Smart Technologies in the Surgical Suite." We explain how recent advancements in intraoperative data acquisition and analytics-combined with physiological monitoring, medical imaging, instrument motion data, surgical video, and environmental metrics-are transforming next-generation operating rooms. We also discuss the challenges that arise when managing data, system interoperability, regulatory compliance, and privacy. In "Robotic Systems in Cardiovascular Interventions," authors Srikanth Reddy Mandhumula and Ali Tavallaei provide a comprehensive survey of 19 commercial and emerging robotic systems, describe the barriers to widespread adoption of existing platforms, and offer valuable insights into current capabilities, limitations, and potential future directions for advancing robotic technologies. From a cardiovascular surgeon's viewpoint, "Robotic-Assisted Vascular Surgery" by Charudatta Bavare, Alan Lumsden, and Jacob Watson imparts a comprehensive clinical perspective on roboticassisted vascular surgery. To unlock its full potential, the vascular community must invest in specialized training, develop dedicated robotic instruments, and define the role of robotic techniques in future clinical practice.

Medical robotics has evolved significantly over the past decades, with more robotic systems than ever now in hospitals. The use of robots for surgery has already revolutionized the surgical landscape by providing high accuracy, greater surgeon dexterity, 3-dimensional visualization capabilities, and the potential for telesurgery. At the same time, diverse medical imaging modalities such as X-ray, computed tomography, magnetic resonance imaging, and ultrasound can provide meaningful visual information required for pre- and intraoperative planning and guidance, which is particularly important for robotic surgery given the surgeon’s limited direct view of the surgical workspace in minimally invasive procedures. This review provides an overview of robotics technology for surgery and image acquisition and describes the main steps involved in the processing of medical imaging and its use. The authors also share their views on what the future of robotics and imaging may look like for surgical applications given the recent advances in artificial intelligence, computer vision, and machine learning.

Advancements in intraoperative data acquisition and analytics are transforming surgical care by integrating diverse information streams into cohesive, real-time decision-support systems. This review explores the use of physiological monitoring, medical imaging, instrument motion data, surgical video, and environmental metrics within next-generation operating rooms. Traditional vital sign monitoring is now augmented by wearable and minimally invasive technologies capable of continuously capturing respiratory rate, heart rate, skin temperature, and hemodynamic parameters such as stroke volume, cardiac output, systemic vascular resistance, and mean arterial pressure. Real-time imaging modalities including intraoperative cone-beam computed tomography, 3-dimensional fluoroscopy with image fusion, ultrasound, and Doppler systems provide dynamic anatomical context to guide precision interventions. Concurrently, computer vision and artificial intelligence tools are being applied to surgical video and kinematic data to identify procedural phases, assess performance, and recognize critical events. Predictive analytics models, trained on large procedural datasets, can anticipate adverse outcomes like excessive blood loss or prolonged operative time, enhancing intraoperative awareness. Smart operating room platforms integrate these multimodal data sources into centralized interfaces, enabling synchronized documentation, workflow coordination, and team communication. Moreover, emerging concepts such as patient-specific surgical simulation and digital twin models offer personalized guidance and outcome forecasting. Despite these advances, challenges remain in managing data overload, achieving system interoperability, ensuring regulatory compliance, and safeguarding privacy.

Ruptured abdominal aortic aneurysm (RAAA) is an acute aortic condition that requires emergent intervention and appropriate continuity of care to optimize patient outcomes. We describe the standardized RAAA protocol at the Houston Methodist Hospital Acute Aortic Treatment Center, developed to navigate critical patient transfer periods safely and efficiently, make crucial decisions about surgical intervention, and clearly communicate these plans with other care team providers. Our workflow is organized into five phases: prehospital, preoperative, intraoperative, postoperative, and post-discharge. We identify the transfer center, anesthesia, operating room nursing staff, surgeons, and intensive care unit as key entities of our acute aortic pathology care team. This systematic protocol for the management of acute aortic emergencies such as RAAA identifies critical decision points, potential complications at each stage, and recommendations for best practice.

Objective: To evaluate a novel technology for real time tracking of RF-Identified (RFID) surgical tools (Biotic System), providing intraoperative data analytics during simulated cardiovascular procedures. Ineffective asset management in the Operating Room (OR) leads to inefficient utilization of resources and contributes to prolonged operative times and increased costs. Analysis of captured data can assist in quantifying instrument utilization, procedure flow, performance and prevention of retained instruments. Methods & Results: Five surgeons performed thirteen simulated surgical cases on three human cadavers. Procedures included (i) two abdominal aortic aneurysm (AAA) repairs, (ii) three carotid endarterectomies (CE), (iii) two femoropopliteal (fem-pop) bypasses, (iv) thoracic aortic aneurysm repair, (v) coronary artery bypass graft, (vi) aortic valve replacement, (vii) ascending aortic aneurysm repair, (viii) heart transplants, and (ix) mitral valve replacement. For each case an average of 139 surgical instruments were RFID-tagged and tracked intraoperatively. Data was captured and analyzed retrospectively. Of the 139 instruments tracked across each of the 13 cases, 55 instruments (39.5%) were actually used, demonstrating a high level of redundancy. For repeat cases (i.e. CE/AAA/fem-pop): (i) average instrument usage was 41 ± 3.6 (8.8% variation) for CE (n=3); (ii) average instrument usage was 69 ± 4.0 (5.8% variation) for AAA (n=2); and (iii) average instrument usage was 48 ± 2.5 (5.3% variation) for fem- pop (n=2). Results also showed a reduction in end-of-procedure instrument counting times of 58-87%. Conclusions: We report on a method for collecting intraoperative data analytics regarding instrument usage via RFID technology. This system will help refine instrument selection, quantitate instrument utilization and prevent inadvertent retention in a patient. This should help increase efficiency in packaging and sterilization and let surgeons make objective decisions in the composition of surgical trays. Clinical and Translational Impact Statement —Intraoperative analytics of surgical tools and associated equipment may ultimately lead to safer more efficient surgeries that increase patient outcomes while decreasing the cost of care.

For every three people on the planet, there are approximately two Tonnes (Te) of plastic waste. We show that carbon recovery from polystyrene (PS) plastic is enhanced by the coaddition of solvents to grow carbon nanotubes (CNTs) by liquid injection chemical vapour deposition. Polystyrene was loaded up to 4 wt% in toluene and heated to 780 °C in the presence of a ferrocene catalyst and a hydrogen/argon carrier gas at a 1:19 ratio. High resolution transmission electron microscopy (HRTEM), scanning electron microscopy (SEM), thermogravimetric analysis (TGA) and Raman spectroscopy were used to identify multiwalled carbon nanotubes (MWCNTs). The PS addition in the range from 0 to 4 wt% showed improved quality and CNT homogeneity; Raman “Graphitic/Defective” (G/D) values increased from 1.9 to 2.3; mean CNT diameters increased from 43.0 to 49.2 nm; and maximum CNT yield increased from 11.37% to 14.31%. Since both the CNT diameters and the percentage yield increased following the addition of polystyrene, we conclude that carbon from PS contributes to the carbon within the MWCNTs. The electrical contact resistance of acid-washed Bucky papers produced from each loading ranged from 2.2 to 4.4 Ohm, with no direct correlation to PS loading. Due to this narrow range, materials with different loadings were mixed to create the six wires of an Ethernet cable and tested using iPerf3; the cable achieved up- and down- link speeds of ~99.5 Mbps, i.e., comparable to Cu wire with the same dimensions (~99.5 Mbps). The lifecycle assessment (LCA) of CNT wire production was compared to copper wire production for a use case in a Boeing 747-400 over the lifespan of the aircraft. Due to their lightweight nature, the CNT wires decreased the CO₂ footprint by 21 kTonnes (kTe) over the aircraft’s lifespan.

Aim: Glycoconjugated C60 derivatives are of particular interest as potential cancer targeting agents due to an upregulated metabolic glucose demand, especially in the case of pancreatic adenocarcinoma and its dense stroma, which is known to be driven by a subset of pancreatic stellate cells. Materials & methods: Herein, we describe the synthesis and biological characterization of a hexakis-glucosamine C60 derivative (termed ‘Sweet-C60’). Results: Synthesized fullerene derivative predominantly accumulates in the nucleus of pancreatic stellate cells; is inherently nontoxic up to concentrations of 1 mg/ml; and is photoactive when illuminated with blue and green light, allowing its use as a photodynamic therapy agent. Conclusion: Obtained glycoconjugated nanoplatform is a promising nanotherapeutic for pancreatic cancer.