Current Applications of Robotic Surgery in Aortic Procedures: A Scoping Review

Objective To map the applications and outcomes of robotic technologies in aortic and aortoiliac procedures, including robot-assisted laparoscopic surgery, endovascular procedures, and micro-robotics. Methods PubMed was searched up to October 4, 2026, for primary studies including at least 3 patients treated with robotic or robot-assisted interventions for aortic or aortoiliac disease, following PRISMA-ScR guidelines. Case reports and two-patient series were summarized separately. Results Fifteen observational studies (552 patients) were included. Robot-assisted laparoscopic surgery (9 studies; 494 patients) was mainly applied to aortoiliac occlusive disease (385 procedures), with robotic proximal aortic anastomosis and open distal anastomoses, and less frequently to aneurysm repair. Conversion rates ranged from 0% to 20%, graft patency from 89% to 100% at up to 48 months, and hospital stay from 4 to 8 days. Robot-assisted endovascular procedures (5 studies; 49 patients) were mostly applied to single procedural steps. Robotic target vessel cannulation succeeded in 81% of vessels, and robotic gate cannulation achieved a shorter catheter path length than manual cannulation (35.7 vs 74.1 cm; P = 0.019), but longer cannulation time. Robotic arch navigation was associated with fewer cerebral high-intensity transient signals (median 0 vs 2; P = 0.018), and operator radiation dose at the shielded console was 96.5% lower than at the procedure table. No robot-related complications were reported. Micro-robotic sac puncture for type II endoleak embolization (1 study; 9 patients) succeeded in all cases. Conclusion Robotic technologies are a promising and feasible option for selected patients undergoing aortic procedures at experienced centers. Robot-assisted laparoscopic surgery showed acceptable conversion rates and favorable mid-term patency, while endovascular robotics improved technical and surrogate endpoints. As current evidence is limited to small observational series, prospective comparative studies are needed to define the clinical benefit of robotics compared with open and endovascular repair.