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数智化助力血管外科疾病诊治进展和未来研究方向
Digital intelligence advances diagnosis and treatment of vascular surgery diseases and future research directions
数智化技术正推动血管外科疾病诊疗向数据与模型驱动转型。在血管外科疾病诊断领域，数智化不仅实现了解剖数据的精准评估，还实现了从静态解剖到动态功能的跨越：基于人工智能的影像分析实现了主动脉瘤等疾病的亚毫米级精准测量与自动化筛查；而四维CT、MRI与计算流体动力学相结合，则能对血流状态进行量化评估；新兴的“数字孪生”技术更可在术前虚拟空间中对治疗方案进行功能学验证与优化。在治疗领域，手术机器人是关键技术载体。血管介入机器人与开放手术辅助机器人已分别在下肢动脉、腹主动脉瘤及各类血管重建手术中证明了其提升操作稳定性与精准度的价值。此外，术中智能导航与增强现实技术通过实时图像融合与血管裸眼可视化，显著提升了手术效率与安全性。在医学教育中，虚拟手术仿真与智能教学系统为血管外科专科医师培养提供了可量化、可重复且无风险的训练平台，正深刻重塑着传统教学模式。然而，数智化的深入应用仍面临技术集成壁垒、高昂成本、数据安全与隐私保护、以及由多元主体带来的伦理与责任界定难题。展望未来，血管外科的数智化发展需聚焦于技术的深度整合与普惠化，同时构建完善的伦理规范体系，最终迈向以医生智慧为主导，人机协同共生的精准诊疗新时代。
Digitalization and intelligence are reshaping vascular surgery towards data- and model-driven paradigms. In diagnostics, digitalization has expanded capabilities from static anatomical assessment to dynamic functional evaluation: artificial intelligence enables submillimeter precision in measuring and screening pathologies such as aortic aneurysms; when integrated with four-dimensional CT, MRI, and computational fluid dynamics, it allows quantitative analysis of hemodynamics; and emerging digital twin technology offers a virtual platform for functional validation and optimization of treatment plans before surgery. In therapeutics, robotic systems serve as key enabling technologies. Both vascular interventional and open surgery-assisted robots have demonstrated enhanced operational stability and precision in procedures involving lower limb arteries, abdominal aortic aneurysms, and vascular reconstructions. Furthermore, intraoperative navigation and augmented reality improve surgical efficiency and safety through real-time image fusion and direct visual mapping of vasculature. In medical education, virtual surgical simulations and AI-driven tutoring systems provide quantifiable, reproducible, and risk-free training environments, fundamentally transforming how vascular specialists are trained. Despite these advances, broader implementation faces challenges such as technical integration hurdles, high costs, data security concerns, and unresolved ethical and liability issues involving multiple stakeholders. Moving forward, deeper technological integration, improved accessibility, and the development of comprehensive ethical frameworks are required to realize a future of precision surgery guided by clinicians in seamless collaboration with intelligent systems.
digitalization and intelligence / peripheral vascular disease / artificial intelligence / precision diagnosis and treatment
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Writing Committee,
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Despite advances in prevention, detection, and treatment, cardiovascular disease is a leading cause of mortality and represents a major health problem worldwide. Artificial intelligence and machine learning have brought new insights to the management of vascular diseases by allowing analysis of huge and complex datasets and by offering new techniques to develop advanced imaging analysis. Artificial intelligence-based applications have the potential to improve prognostic evaluation and evidence-based decision making and contribute to vascular therapeutic decision making. In this scoping review, we provide an overview on how artificial intelligence could help in vascular surgical clinical decision making, highlighting potential benefits, current limitations, and future challenges.Copyright © 2023 Elsevier Inc. All rights reserved.
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BACKGROUND
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Catheters are typically stiff and incorporate a pull-wire mechanism to allow tip deflection. While standing at the patient's side, the operator manually navigates the catheter in the heart using fluoroscopic guidance.A total of 42 patients (32 female; mean age, 55+/-15 years) underwent ablation of common-type (slow/fast) or uncommon-type (slow/slow) atrioventricular nodal reentrant tachycardia (AVNRT) with the use of the magnetic navigation system Niobe (Stereotaxis, Inc). It consists of 2 computer-controlled permanent magnets located on opposite sides of the patient, which create a steerable external magnetic field (0.08 T). A small magnet embedded in the catheter tip causes the catheter to align and to be steered by the external magnetic field. A motor drive advances or retracts the catheter, enabling complete remote navigation. Radiofrequency current was applied with the use of a remote-controlled 4-mm, solid-tip, magnetic navigation-enabled catheter (55 degrees C, maximum 40 W, 60 seconds) in all patients. The investigators, who were situated in the control room, performed the ablation using a mean of 7.2+/-4.7 radiofrequency current applications (mean fluoroscopy time, 8.9+/-6.2 minutes; procedure duration, 145+/-43 minutes). Slow pathway ablation was achieved in 15 patients, whereas slow pathway modulation was the end point in the remaining patients. There were no complications.The Niobe magnetic navigation system is a new platform technology allowing remote-controlled navigation of an ablation catheter. In conjunction with a motor drive unit, this system was used successfully to perform completely remote-controlled mapping and ablation in patients with AVNRT.
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Catheter guidance in a critically ill neonate can be difficult and hazardous. A new technique of directing a catheter based on the interaction of magnetic fields is described. A strong external permanent magnet is moved across the body surface to control the magnetic tip of a catheter in the body. We report on the first clinical case of such a heart catheterization in a neonate with complex congenital heart disease. This method can also be used for other invasive investigations in the neonatal period.
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Ablation of complex arrhythmias would be greatly facilitated by more precise control of ablation catheters. A feasibility study was performed in animals to evaluate a novel magnetic guidance system (MGS) that generates a magnetic field to control the movement and position of a magnetic ablation catheter.The MGS is composed of a digital biplanar fluoroscope within an array of superconducting electromagnets that surround the torso of the experimental animal and a computer control system that generates a composite magnetic field for directional catheter deflection. Magnetic catheter navigation was performed in dogs and pigs (20 to 30 kg). A 7F magnetic ablation catheter was used for intracardiac navigation and radiofrequency ablation. The performance of a standard 7F deflectable catheter was not affected by the MGS. The magnetic catheter was navigated successfully to 51 predefined targets throughout the heart in 6 animals. In 5 animals, the magnetic catheter, guided by a 3D computed tomogram, was successfully navigated to all pulmonary veins. Navigation accuracy was estimated as <1 mm displacement from the target. The magnetic catheter was used to ablate the atrioventricular node in 4 animals and to perform linear ablations across the endocardial surface underlying an epicardial multielectrode recording plaque in 4 animals.These results demonstrate that the MGS can navigate and stabilize an ablation catheter at endocardial targets. Linear or focal radiofrequency ablation with the magnetic catheter is not compromised by the magnetic field. This technology provides precise control of endocardial catheters.
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Objectives: The aims of this study were to demonstrate the safety and the feasibility of the robotic catheter remote control system (CCS) in endocardial navigation in all cardiac chambers, as well as facilitation of the transseptal puncture.
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Recently, the use of robotic assisted surgery has been utilized in cardiac surgical procedures. The use of robotics may offer benefits in precision, stability and control of instruments remotely. We report early experience with a novel remote robotic catheter control system (CCS).We used a computerized robotically controlled catheter system that enables the user to remotely manipulate the tip of a catheter precisely in three dimensions. We tested the robotic catheter control systems ability to navigate within the heart and to make precise, rapid and repeatable movements. We compared the CCS with the ability of a standard quadripolar steerable ablation catheter placed in a deflectable sheath to navigate and make precision movements. Twelve ex-vivo porcine hearts were utilized to permit accurate measurements of navigation and precision. Eight targets were selected for navigation and precision testing. Time was measured for the catheter to reach the predefined target from a specific starting point to test navigation. In addition, time was measured to contact a discrete 0.8 mm target in order to test precision.The use of the CCS reduced the time needed for both navigation (8.5 +/- 13.9 sec vs. 22.7 +/- 26.7 sec, p = 0.002) and significantly decreased the time for precision targeting (10.1 +/- 6.9 sec vs. 29.6 +/- 26.4 sec, p < 0.001) in the specific RA and LA sites in the ex-vivo hearts.The use of a computerized robotically assisted catheter control system is feasible and shows promise in rapid precision movement of the catheter. Further study is needed to elucidate the role of such a system in-vivo and in patient specific catheter ablation and mapping.
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We report the surgical management of an expanding 2.5-cm left-sided renal artery aneurysm using a robotic-assisted laparoscopic approach. Using the da Vinci surgical robotic system, we resected the aneurysm, and the anterior-inferior branch of the renal artery was reconstructed with an end-to-end anastomosis. The operative time was 360 minutes, hospitalization length of stay was 3 days, and postoperative analgesic requirements were minimal. Follow-up imaging and functional analysis demonstrated resolution of the aneurysm and preservation of renal function. This technique highlights the ability of surgical robotics to expand indications for minimally invasive surgery in complex cases.
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Although splenic artery aneurysms (SAAs) are relatively uncommon, they are clinically relevant because of the risk of rupture. Optimal management is a matter of debate and involves the use of percutaneous endovascular stenting, which has limitations, versus the open surgical approach which can lead to significant morbidity. The present study reports the outcomes of robot-assisted surgery for SAA and its role in overcoming many of the limitations of laparoscopy.A total of nine patients with incidentally detected SAAs underwent a surgery between September 2001 and November 2007. Six of these nine patients underwent a robot-assisted splenic aneurysm resection with vascular reconstruction. The remaining three cases included one robotic arterial ligation, one robotic partial splenectomy, and one laparoscopic splenectomy.The mean operating time was 212 ± 61 minutes (range: 90-300), mean intraoperative blood loss was 186.6 ± 202.4 mL (range: 0-500), and mean hospital stay was 7.1 ± 3.7 days (range: 3-14). The morbidity rate was 11.1% and no mortality was reported. Doppler-ultrasonography surveillance showed regular organ perfusion in all patients with vascular reconstruction.Robot-assisted surgery for SAA represents one of the most advanced developments among minimally invasive procedures and can become an important option for the treatment of this disease.Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
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We report our initial experience with a novel robotic-assisted dissection of the infrarenal aorta and iliac arteries for the treatment of aortoiliac occlusive disease and abdominal aortoiliac aneurysm. Seven patients underwent the procedure using the da Vinci Surgical System. Transabdominal, retroperitonal dissection of the aorta and iliac arteries was completed using the robotic system; then, a mini-laparotomy and hand-sewn aorta-to-graft anastomosis were performed. There was no mortality in this series of patients. This novel technique may overcome the difficulty of aortic dissection in a purely laparoscopic aortic surgery and serves as a bridging step toward totally robotic-assisted aortic surgery.
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田欣尧, 王伟林. 人工智能时代外科教学技术赋能与人文坚守[J]. 医学与哲学, 2025, 46(11):56-60. DOI:10.12014/j.issn.1002-0772.2025.11.12.
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刘一人, 谷涌泉, 郭连瑞. 元宇宙在血管外科教学中的应用[J]. 安徽医药, 2024, 28(9):1901-1904.DOI: 10.3969/j.issn.1009-6469.2024.09.044.
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王宇涛, 葛文嘉, 商鹏, 等. 数字智能化技术在外科临床教学中的应用研究[J]. 卫生职业教育, 2025, 43(15):11-15. DOI:10.20037/j.issn.1671-1246.2025.15.04.
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