An Exciting Frontier: The Rise of Robotics in Interventional Oncology
© 2025 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of IO Learning or HMP Global, their employees, and affiliates.
by Laura Simson, MA
In advance of the 2025 SIO conference, Dr Bruno C. Odisio, MD, PhD, FSIR, FCIRSE, and Iwan Paolucci, PhD, spoke with Vascular Disease Management about their upcoming sessions on Robotics, Navigation, Guidance, and Confirmation.
Compared with surgery, interventional oncology offers a myriad benefits, including reduced invasiveness, faster recovery, and lower cost without compromising overall survival, as demonstrated by the recently published COLLISION Trial. However, there are still areas in which this field is falling short, such as local tumor control rates, which may be attributed to the lack of standardization in the way people practice ablation procedures around the world. This is the problem Dr Odisio seeks to address: how we can incorporate novel technology to allow us to better plan, target, and assess treatments, and ultimately provide a comprehensive and scalable solution for all patients?
Navigation and robotics, along with augmented reality and artificial intelligence (AI), are one way of levelling this global playing field. Early training with AI algorithms can jumpstart an interventionalist’s practice in liver ablation, as they now have the amalgamation of decades of experience at their fingertips. With the incorporation of percutaneous robots into practice at centers with less experience, interventionalists have the potential to replicate the results of their more experienced counterparts. Robots can also expand access to complex procedures, which operators may not have the tools to perform otherwise, ultimately increasing the number of treatable patients.
Dr Odisio also calls attention to the role of software in advanced imaging modalities. The data supporting the use of software to evaluate ablative margins as an imaging biomarker is becoming increasingly robust. Through the COVER-ALL Trial, an NIH-funded randomized trial at MD Anderson, demonstrated improvement of ablative margins with the use of software-aided margin assessment than just by visual inspection, which is still common practice. Through the ongoing ACCLAIM Trial, investigators hope to show that using software-based ablation confirmation methodology should be the standard of practice when treating colorectal cancer liver metastasis patients with liver microwave ablation.
However, challenges like reimbursement and access remain an obstacle to the realization of the full potential of robotics in this space, and raising awareness is a crucial step to overcome this barrier. Showcasing real-world data and emphasizing the integration of advanced imaging and robotics across all experience levels will help establish these technologies as standard practice and ultimately ensure that all patients have access to the same level of care.
Read the excerpt of the full interview below.
Thank you so much for meeting with me today! Can you please tell us a bit about the sessions you are leading at SIO?
Dr. Odisio: The event is structured into two main sessions. First, there’s an educational session featuring formal lectures designed to provide foundational knowledge and insights. Following that, we’ll have a hands-on workshop, where participants can get a glimpse of the technologies available in clinical practice. The idea behind this format stems from the growing recognition over the past few years of how pivotal interventional oncology procedures have become in clinical practice. This is particularly true for percutaneous image-guided ablation techniques, which are now central to managing both primary and secondary liver tumors. Our goal is to not only highlight their importance but also empower participants with the knowledge and skills needed to integrate these advancements into their own practice.
Another exciting aspect of the workshop is the incorporation of augmented reality (AR) and artificial intelligence (AI). AR has the potential to streamline workflows, particularly in multimodality procedures, by integrating imaging in a more efficient, ergonomic-friendly way. On the AI side, many solutions we’ll showcase include algorithms trained on vast datasets of prior cases, essentially bringing the expertise of experienced interventional radiologists to early-career physicians. This combination of innovation and accessibility has the potential to transform how we approach these procedures in everyday clinical practice.
Dr. Paolucci: Thermal ablation of liver tumors has made huge advances due to the use of navigation, robotics, and artificial intelligence-enabled ablation margin confirmation. These advancements are developed and clinically studied by different research groups and industry partners often focusing on one of these aspects. With these two sessions we aim to bring everybody together and present a complete overview of those achievements covering fundamentals and clinical evidence in the educational session and practical application in the workshop. I think it is a great opportunity both for early-career physicians who did not have access to these technologies in their training and also for seasoned physicians who are interested in these technologies. As a Biomedical Engineer, I’m excited that we have the opportunity here to talk about the fundamentals and the clinical evidence at the same time.
I read your review paper that was published in Diagnostics about a year ago, and I read that you were advocating for robotics being integrated into training. Do you think that that's being implemented adequately? Do you think that people are getting the proper access to those in their early career?
Dr. Odisio: Great question. Robotics is an exciting frontier in interventional oncology, especially for percutaneous procedures. While well-established in surgery, robotics in IR has the potential to standardize outcomes, helping less experienced centers replicate the success of top institutions. This is critical as studies like the COLLISION Trial show ablation can achieve similar outcomes to surgery in colorectal cancer liver metastases, with fewer complications and faster recovery. Robotics can help ensure precision and consistency needed for these results. On the education side, training the next generation of interventional radiologists to use robotics is vital. This requires sufficient access to the technology within training programs. Some have expressed concerns that relying on robots might diminish freehand skills for complex procedures, but I see it differently. Robotics can enable more complex, precise interventions that might not be possible otherwise, ultimately expanding the number of patients we can treat effectively.
Dr. Paolucci: I think this field is facing similar challenges as artificial intelligence when it comes to training. Interventional Radiologists acquire knowledge about the fundamental physics of imaging systems they use. However, to date there is no training on fundamentals in navigation or robotics (and artificial intelligence for that matter) unless they are fortunate enough to train in a center where these technologies are available are part of research. Therefore, those devices often represent black boxes that IRs are supposed to trust when performing their procedures. If they know about the fundamental principle of these, I am certain, it will empower them to get much more out of these devices which ultimately will benefit the patients.
We also have to realize that although we call these systems robotic, they have little to no autonomy and simply provide assistance or guidance. This is not to discount all the achievements made to date but rather to highlight that we are just at the very beginning. In an analogy to the automotive industry, we basically just discovered cruise control, and lane keep assist systems. I expect rapid advancements in this area over the next decade and it is therefore very important that we include it into the training. Importantly, training is necessary for the entire team including the nurses, IR technologists, and anesthesiologists.
What kind of sessions you think would be helpful at conferences such as CIO and SIO to make sure that everyone has the proper education about robotics as we move forward in this space?
Dr. Odisio: We’re still at a stage where raising awareness about the opportunities offered by advanced imaging, stereotactic systems, and robotic guidance in IR is crucial. Conferences like these should include sessions that not only explore the technology but also present real-world and prospective data on their use to drive adoption and understanding.
Dr. Paolucci: Dedicated scientific sessions are necessary to disseminate new advancements and present the clinical evidence around these systems. In addition, hands-on workshops are probably the best way to introduce an audience into this technology. From personal experience, I took multiple courses at university about navigation and robotics, but it was only after being able to use a system on phantoms and seeing it in the operating room that I truly understood them.
