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Health care executive David Fischel discusses his article “How robotics are reshaping the future of vascular procedures.” David explains how robotic-assisted systems are overcoming long-standing challenges in endovascular care by improving precision, reducing variability, and easing the physical strain on clinicians. He outlines the technical and practical barriers that limited earlier adoption, from workflow inefficiencies to high costs, and shows how modern platforms—through integration with imaging, user-centric design, and better throughput—are driving a new era of adoption. David also reflects on the evolving role of the surgeon, shifting from hands-on operator to strategic overseer, and highlights the benefits robotics bring to patients, physicians, and health systems alike. Listeners will gain insights into how robotics are redefining vascular care and why their widespread adoption signals a new foundation for precision interventions.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome David Fischel, he is a health care executive, and today’s KevinMD article is “How robotics are reshaping the future of vascular procedures.” David, welcome to the show.

David Fischel: Hi. Thanks a lot for having me.

Kevin Pho: Well, thank you so much for joining me. I know you are at a conference, but let us briefly share your story and journey for those who did not read your article or know you.

David Fischel: Sure. So I am the CEO of a company called Stereotaxis. We are leading the charge in terms of advancing robotics in the field of endovascular surgery, mainly minimally-invasive cardiovascular procedures. Prior to that, I came to this through the finance and investing world where I have invested in medical device companies for a couple of decades by now. So that is me, very brief.

Kevin Pho: All right, so let us talk about your article. Specifically that intersection between robotics and vascular procedures. I know robots are certainly being used in urological and gynecologic procedures, but tell me how it is being used in vascular procedures.

David Fischel: Sure. So if you think about procedural medicine as a whole, you can categorize surgeries into three rough, very big buckets: open surgeries where you have an open incision with the physician holding tools over the patient; laparoscopic surgery where you are using three, four, or five little holes with functional sticks through those holes; and then endovascular. “Endovascular” means within the blood vessels. You are using the blood vessels of the body as a form of a superhighway to get wherever you want to perform the procedure.

That transition from more invasive to less invasive, from open to laparoscopic to endovascular, has played out in many fields of medicine. When you talked about urology or gynecology for robotics, that really touches upon the da Vinci system, which is the most impactful robot. It is by now treating a couple of million patients a year, and there are ten thousand-plus da Vinci systems out there in the world. That has really transformed laparoscopic surgery, from urology to gynecology, to thoracic surgery, to abdominal surgery. Robotics in laparoscopic surgery is a major, major force. Similarly, in the open surgical space, you have robots for orthopedic surgeries: knees, hips, and spine. That has also played out, probably a decade after laparoscopic robotics, but it has played out in a major way.

In the endovascular field, there are essentially no robots, and that is what Stereotaxis is really focused on. In a typical endovascular surgery, you are inserting catheters, small one-millimeter or two-millimeter-in-diameter catheters, through the blood vessels. You usually access the blood vessels through the leg or the arm, and then you will navigate the catheter to the heart or to the brain or to the periphery, or to wherever else you need to deliver therapy. The challenge with robotics in the endovascular field is that what you typically think about when you think about industrial robots does not work. You need flexibility to navigate the tortuous ostia of the vasculature, and you need to work in very small, delicate anatomy. The normal ways you think about metal and hard robots do not work in that environment, and that is where we came in with a very different approach to advance robotics in that field.

Kevin Pho: So tell us the type of vascular procedures that your technology best addresses.

David Fischel: Today I am at a conference by the Heart Rhythm Society. It is really focused on the treatment of patients that have heart arrhythmias. When the heart does not beat regularly, that can lead to issues, obviously. There is a fairly common procedure, there are probably about one and a half to 1.7 million procedures like this done a year, where you navigate a catheter into the heart and then you actually burn some of the misbehaving heart muscle cells. By doing so, you get the heart to beat in a normal rhythm again. These are called cardiac ablation procedures, and that is our most common procedure performed with our system. By navigating the catheter robotically, you allow for a level of precision, stability, and safety that is otherwise impossible to have with a typical handheld catheter. That is really where we add value. Physicians have used our technology to treat about 160,000 patients to date in that field. Then there are some other fields where we are starting to try to advance robotics as well, but cardiac ablation to treat heart arrhythmias is really our core market right now.

Kevin Pho: And tell me the type of outcomes data do you have for people who use your approach?

David Fischel: It depends. There is obviously a wide range of arrhythmias and there is a wide range of outcomes depending on that and depending on the user. But when you look at the overall data on robotics in the field of cardiac ablation, you see several consistent themes in the clinical data, regardless of the operator or the types of arrhythmias. The main themes are safety. Because we are navigating a catheter from the tip directly, you do not need a rigid catheter. You can have a very soft, gentle catheter that is being navigated by the robot, and that allows you to have a catheter that is atraumatic in the heart. One of the risks in typical cardiac ablation procedures is that if you move the catheter too quickly or too hard against the tissue, you can puncture the heart. That happens in around one percent of cases. Consistently in every clinical study, you see a significant reduction in major adverse events, in heart punctures, and other adverse events.

A second big theme is enabling physicians to treat complex patients that otherwise would not be good candidates for therapy. If you think about patients who were born with congenital heart defects, so pediatric patients, or patients where you are trying to treat arrhythmias that are sourced from the lower chambers of the heart, from the ventricles of the heart, it is more difficult to get there, and those chambers pump harder, so it is also more difficult to stay stable on the tissue. Those are the types of procedures where we do very well. There is one of the largest studies in the VT space, ventricular tachycardia, which is a type of a more complex arrhythmia. It was about an 800-or-so-patient study, and they looked at efficacy, safety, and efficiency of the procedure and showed statistically significant improvements in all three of those robotically versus manually. Those are the areas we really enable: the more complex, dangerous, and challenging procedures to get done well, so that you can expand minimally-invasive therapy to patients that otherwise would not get that therapy.

Kevin Pho: Now, how about from the perspective of the proceduralist? I am an internal medicine physician, so I am actually not that familiar with the ablation procedure. Maybe contrast the two stories. How is it traditionally done, and contrast that with how it is done robotically from the perspective of the proceduralist. What is it like for them?

David Fischel: For a physician, if you want to paint an image in your mind, in a typical cath lab, the operating room where all of these procedures get done, you usually have an X-ray right in the center of the room with an operating table right by the X-ray. X-rays are the primary form of visualization during these procedures. A physician would stand by the table, and they would insert catheters into the patient’s leg, and they would be standing there manipulating the catheters with their fingers and wrists. That is how a typical procedure looks.

The challenge for the physician is that they are doing hours worth of procedures a day, and they are standing there very close to the X-ray beam. They are wearing a lead vest to protect themselves from the X-ray, so they are wearing twenty to thirty pounds of lead on them, standing close to the X-ray and being exposed to radiation for the entire procedure. They are having to do micro-movements of their hands to try to move a catheter in the body.

What we do with the physician is that when they do a robotic procedure, they unscrub and go to a control room, which is right by the operating room, two, three, four, or five meters away. They sit behind a computer cockpit, and then they are using a keyboard and mouse to really steer the catheter. On this large screen display where they get all the diagnostic information on the patient, they can say they want to move the catheter in this area or that area of the heart, and we know how to adjust the magnetic fields around the patient accordingly to steer the catheter as they wish. They are doing the entire procedure seated, in full control of things, without being exposed to radiation.

The beauty there, and as a physician, it will probably resonate very well, is that a physician in procedural medicine has to have two big skills. You have to have the cognitive skill of being able to understand the patient in front of you, why they have a disease, what the issue is with them, and how you want to treat them. Then you have to have the hand skills: how do you get the tools at your disposal to actually do what you want them to do? When you put a physician behind the robot, it allows the mechanical aspect of the procedure to be simplified so that they can spend more of their mental focus on the cognitive aspect. As a patient, if you were lying on the table, you would want your physician to not be stressed, to not be tired, and to be able to be fully focused on the cognitive aspect of the procedure.

Kevin Pho: And what kind of training does a physician need to become proficient in your system?

David Fischel: Physicians in the cardiac ablation field go through a huge amount of training. They do internal medicine like you did, they do interventional cardiology, and then they do a subspecialization in electrophysiology, which is the electrical signals of the heart. We actually offer a robotic electrophysiology fellowship program at a couple of dozen or so hospitals where fellows who are going through their typical electrophysiology training also get trained on robotics through simulators and through procedures. When they graduate, they graduate with expertise in robotics as well. Robotics is more intuitive. Hand motions are very non-intuitive. You learn it like learning how to play a piano. Robotics is much more intuitive, but there is also a learning curve there, and we have simulators and procedural training that allows fellows to get proficient.

Kevin Pho: Any other conditions other than ablations that you can see your technology being applied to now or in the future?

David Fischel: Definitely. One of the big challenges in the broader field of endovascular surgery is navigating tortuous, twisty, winding vasculature and getting where you need to deliver therapy. If a patient has a stroke, oftentimes to get to the point in the brain where the stroke has taken place to be able to pull out the clot or aspirate the clot out is very difficult. If you are trying to deliver embolization agents for a liver tumor, getting to the right blood vessels that are feeding the tumor to occlude them can be very difficult. In some of the coronary cases, if you have total occlusions of coronary vessels, getting through them can be very difficult.

When we steer our interventional devices directly from the tip, rather than applying forces two, three, or four feet away at the handle and hoping that you can steer the tip through the translation of the control over that entire length of the flexible device, it allows you to steer things in a way that is otherwise impossible. The magnets of our robot are like invisible fingers, allowing you to hold onto the tip of the catheter, and that is what gives it the precision and the stability. We have developed a family of guide catheters and guide wires that help physicians steer through that tortuosity. I hope over the coming year we are going to start to show the value of the robot in procedures like stroke, liver tumors, complex coronary cases, and complex peripheral cases.

Kevin Pho: And how readily available is this technology?

David Fischel: We are still a young company and relatively in the early stages of our commercialization. We have been working predominantly on a lot of engineering efforts and clinical regulatory efforts over the last five or six years. We have about one hundred hospitals around the world that are using our robot. As I mentioned before, over 150,000 patients have been treated with the robot. But a big effort of ours has also been how do you make the robot more accessible? The original robot, the robot that is still being used predominantly around the world, requires a hospital to do a decent amount of construction in order to actually accommodate the robot and build a lab that can accommodate it.

We got a CE mark in Europe for a newer robot recently. We also submitted in the U.S. for FDA approval for that robot, and that will make robotics much more accessible so a hospital does not have to do construction to build a robotic cath lab. That is a big goal of ours. You can have the coolest, most beneficial technology in the world, but if it is not readily accessible, then obviously its impact is muted. At the end of the day, we are a medical device company. Our goal is that there is an unmet medical need. Patients still suffer out there. There is room to improve medicine. You want to make your technology broadly accessible so it can have the biggest impact that is possible.

Kevin Pho: We are talking to David Fischel. He is a health care executive, and today’s KevinMD article is “How robotics are reshaping the future of vascular procedures.” David, let us end with some take-home messages that you want to leave with the KevinMD audience.

David Fischel: I am delighted to be on the show. I think working in medical devices, the innovation of devices, and thinking about unmet medical needs and how to pioneer new areas of medicine is probably the most fascinating journey one could go on. So anyone who is interested to go on that journey, I encourage you to go through it. It is a winding, tough path, but it is an awesome, awesome one.

Kevin Pho: David, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

David Fischel: Thank you.