Manual, Joystick, or Haptic Control? An In Vitro Comparison of Navigation Strategies for Robotic Interventional Neuroradiology Procedures

Benjamin Jackson, Nikola Fischer, Harry Robershaw, Xingyu Chen, S. H. Hadi Sadati, Yang Li, Jeremy Lynch, Nasr Abdelsalam, Jonathon Buwanabala, Matthew Benger, Sara Sciacca, Naga Kandasamy, Marco Mancuso-Marcello, Parthiban Balasundaram, Sahan Guruge, Neelan Das, Alejandro Granados, Kawal Rhode, Thomas C Booth

Objective: To evaluate robotic controller interfaces for interventional neuroradiology procedures in-vitro incorporating a force-sensing platform to assess safety. Methods: A custom endovascular robot, device-mimicking controller, and sensorized neurovascular phantom were developed. Ten interventional neuroradiologists (4 novices, 6 experts) performed simulated navigations using four control modalities: device-mimicking controllers with and without haptic feedback, joystick-based input, and manual navigation. Navigation time, peak vessel-wall forces, incorrect catheterisations, and prolapse events were assessed, alongside user analyses. Results: Manual navigation was fastest (mean 47.7 s) compared to haptic-on (248.7 s), haptic-off (314.7 s), and joystick (392.6 s) modalities (p<0.001). Regardless of controller type, vessel-wall forces were below the 0.70 N puncture threshold; therefore all modalities were considered safe. Joystick produced significantly more prolapse events than manual control (1.56 vs 0.13; p=0.018). Operator experience was relevant to performance: experts made fewer incorrect catheterisations than novices (0.25 vs 0.62; p=0.035) and applied less vessel-wall force (p<0.0005); these effects were sustained across controllers but accentuated when haptics were on. Users perceived haptic on and haptic off as similarly intuitive, and more intuitive than joystick (p=0.033). Conclusion: Device-mimicking robotic controllers outperform joystick interfaces on most metrics; haptic feedback shows promising but non-significant performance benefits.