Do robot-assisted percutaneous vascular interventions improve effectiveness and safety compared with manual procedures: protocol for a systematic review and meta-analysis

BACKGROUND: Robot-assisted percutaneous vascular interventions have emerged as a promising technology across cardiovascular, neurovascular, and peripheral vascular procedures. Although robotic systems may offer advantages such as enhanced precision and reduced radiation exposure, their clinical effectiveness and safety compared with conventional manual techniques remain uncertain, and the current level of procedural autonomy has not been systematically evaluated. This study seeks to provide direct and practical clinical evidence for clinicians. METHODS AND ANALYSIS: In this protocol, Preferred Reporting Items for systematic review and meta-analysis Protocols were followed. A comprehensive search will be conducted in PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials from inception to January 31, 2026. Inclusion criteria encompass randomized controlled trials and observational studies (both comparative and single-arm) evaluating robot-assisted interventions across cardiovascular, neurovascular, and peripheral vascular territories in adult populations. The primary outcomes are clinical success rates and major adverse cardiovascular/cerebrovascular events (MACE) rates. Secondary outcomes include technical success rates, procedural efficiency metrics, and radiation exposures. Comparative studies will be used for the primary effectiveness analyses, whereas single-arm studies will be analyzed separately as descriptive and supportive evidence. We will assess the quality of evidence, heterogeneity, and reporting bias following the recommendations of the Cochrane Handbook for systematic reviews of interventions. DISCUSSION: This systematic review will synthesize high-quality evidence on the comparative efficacy and safety of robot-assisted versus manual vascular interventions, with territory-specific analyses as the primary analytical framework. Any pan-vascular pooled estimate will be considered secondary or exploratory and interpreted in the context of cardiovascular, neurovascular, and peripheral vascular-specific findings. By clarifying the true clinical value of endovascular robotics across multiple territories, our findings will directly inform clinical decision-making, optimize procedural strategies, and guide future technological innovation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251231572.