How Emory Became the First Adopter of the Liberty Endovascular Robotic System

Emory University Hospital was recently selected as the first medical center to adopt the Liberty endovascular robotic system, developed by Microbot Medical and granted 510(k) clearance by the FDA in September 2025.^1,2 The portable, disposable robot has since been used at Emory for a range of procedures, including treatment of enlarged prostates, arthritis, and liver cancer. An interventional radiologist guides this robot using a hand-held controller resembling a video game joystick. CancerNetwork® spoke with one such interventional radiologist, Zachary L. Bercu, MD, RPVI, FSIR, about this procedure.

In part 1 of this interview, Bercu explained how the Liberty system works from the operator’s perspective, the learning curve associated with adopting it, and what it changes about precision and control compared with manual endovascular navigation. He also discussed what went into Emory becoming the technology’s first adopting site and reflected on his own background with video games as it relates to picking up the controller-based system. Part 2 of this interview covers the technology’s clinical applications in liver and kidney cancer, its implications for operator radiation exposure and physical strain, and its potential for remote, or “telecatheterization,” procedures.

Bercu is a professor in the Department of Radiology and Imaging Sciences and program director of Interventional Radiology Integrated and Independent Residency Programs at Emory University School of Medicine. He is also an adjunct professor in the Department of Biomedical Engineering at Georgia Tech.

CancerNetwork: How does the Liberty endovascular robotic system work from the operator side?

Bercu: The Microbot Liberty System is, for lack of a better term, what I call a BYOMC device—”Bring Your Own Microcatheter and Microwire….” Previous endovascular robots were huge footprint devices that were in an angiosuite—they were often very expensive and sometimes would have a unique wire or catheter that was associated with them. This one basically controls the microcatheter and the microwire. It’s a portable disposable robot, so we call it PEDRA, or Portable Endovascular Disposable Robotic Assistant, and you take it out of a box that’s no bigger than a box for a video game system. The device itself sits very close to the patient on an arm that attaches to the side rail, and inside that device is whatever microwire and microcatheter that you want to use. Once it’s placed and set up through that device, you can control those with a remote controller that basically looks like a video game controller; an FDA-approved video game controller. It requires 2 hands to [use], so that if you accidentally dropped it, it wouldn’t accidentally move.

It gives you fine motor control over both the microwire and the microcatheter. With the microwire, you can basically go forward or backwards, clockwise or counterclockwise, turning the microcatheter forward or backwards. It can do some basic movements with the larger base catheter that’s inside, but for the most part, this is about controlling the microwire and the microcatheter.

What level of training is required with the controller?

What’s fascinating about this, and we haven’t studied this yet, but we have a working hypothesis that those who play video games, probably, adapt sooner to the device than those who do not. It’s pretty quick to pick it up. Now, there is some adoption because it is platform technology, so it is different from the way that we would move and rotate a microwire in our hands and advance our microwire. With this, instead, you pick up the controller. On the right side of the controller are the controls that manage the microwire. On the left side are the controls that manage the microcatheter. There’s a bit of an adjustment. For those who play video games, we’re theorizing this, and we really need to study this, that the adoption is quite quick because it feels a bit like getting a quick tutorial for how you’re introduced to a new video game, and then you pick it up pretty quickly from there.

What does this technology change about precision and control compared with how you would typically navigate blood vessels by hand?

It doesn’t change what we do with our hands already. It gives us fine motor and micro motor control over that. Because it’s a system that really grips strongly on the microcatheter and microwire, it almost gives you a ] bit of tension control over that, especially when you’re going through tortuous anatomy. So again, fine motor control and then a grip motion through tortuous anatomy. Some of the additional benefits that we’re looking at is when you have the robot set up, you can move and change position any which way you want. We’ve noticed that we start to rotate away and we get into more of an ergonomic position as the operator, looking at the screen, instead of being hunched over where we have to control with our hands and then look at the screen at an awkward angle. We can now be more comfortable, and that may have downstream impacts on the operator’s comfort and ergonomics, and long-term back disability, which is a huge thing. If you have a wireless foot pedal, you can move outside of the room and not be exposed to radiation—for the contrast injection, you still have to be in the room, but I suspect that’s just a technological issue that in the future will be managed and solved.

Then, ultimately, some of the ways that we’re thinking about this, which is really more downstream, is: does this create the ability for the operator to potentially not even be in the same physical space as the patient. If the patient, from a mobility perspective, can’t reach the center of excellence, can the center of excellence reach the patient? It’s the whole concept of tele-catheterization and tele-surgery. Tele-surgery probably has a little more ground time in the surgical robotic space, and for telecathetization, there’s been some initial work with fixed, large devices that I referenced earlier. We’re really envisioning this in a novel way. All of those are potential downstream benefits of having a robotic system like this. In its initial phase, we’re really looking at the basic initial component, which is the fine motor control and some of the ergonomic function, as well as potentially also being a little further away from the beam and reduced operator exposure to radiation.

Emory is the first site to adopt this system, so what goes into being the first site to put something like this into operation? What kind of training did it require for the operators and support staff?

I personally am not new to endovascular robotics because of my Georgia Tech work. I’ve been involved for several years on preclinical work on endovascular robotics. We were also an early site looking at percutaneous robotics, so I subdivide into 2 categories, endovascular and percutaneous. For percutaneous robotics, now there are several devices on the market that can drive a needle from outside of the body into a target. This is different, in that this is endovascular robotics, so [we’re] controlling the microwire and microcatheter. But what goes into this, from the perspective of Emory, that makes us ideally suited to this, is that we’re a site that not only the current state and where we’ve come from, but where are we going. When we really think about the next 20 years of cancer care, for instance, what does precision medicine look like? What does it look like when we have fine motor control and can get deeper into vessels, closer to tumor, to adjust the risk-benefit ratio of how we treat? I’m grateful to be at an institution that sees that as part of our mission: to address unmet clinical needs for patients using innovative technology like this. We are strong believers that this is potentially platform technology, and with our expertise and experience, we think that we’re an ideal site to pursue this work.

Regarding how quickly somebody adopts it, it is platform technology, so I want to caution that many people in technology-driven fields like ours have this idea that you can drop a piece of technology in, and immediately, with the first case, you see this incremental benefit. We know that that’s not what happens on the ground. There’s an adoption phase. You bring a piece of technology in, you learn the ins and outs, and you learn your own site culture—the approach and methodologies that work, and who does what. We’re talking about interprofessional teams of physicians, nurses, technologists. Oftentimes we have anesthesiologists and anesthetists who are part of our cases. What that looks like, bringing it into an institution, is going to be very site-specific. However, one of the things that we’ve noticed, and again, we’re still studying this, so don’t hold me to this number, but roughly, empirically, we’re seeing it takes about 5 cases to get to your steady state of how quickly can you get the sidearm on the rail, get the robot, decide you’re going to use it in a case, and then pick up the controller and be ready to go. It does not take a very long time compared with other technologies where there’s a real learning curve, but it is platform technology, and it’s different.

One of the other aspects I want to make a side note of is that we’ve all developed our tips and tricks for tortuous anatomy—different things that we do heuristically. We don’t always figure out how we articulate it, but we studied this years ago. We studied whether, without getting too into the weeds of human factors, you could show angiographic images, these were all phantom models, between somebody who’s a novice and an expert, to a bunch of people who have no expertise in medicine, and they could tell who was the expert and who wasn’t. This was based on research out of the urology world. There’s something that we do heuristically that we don’t always articulate. But we know we’re going to develop those tips and tricks with the robot. For example, there’s certain tortuous anatomy that I figured out a tip and a trick for how we do that, that’s different from how we would do it with our hands. These are all the things that, as this platform technology evolves—if you’ll forgive me for referencing this, I’m of the Nintendo generation—I’m figuring out what the “Konami” code is to navigate the tortuous anatomy. We’ve got some tips and tricks already up our sleeve for what we do with the controller, as the “cheat code” to get around some of those nuances.

It sounds like you’re literally video gaming it. So you had history with video games before going into the system?

Yes. As somebody who’s in the innovation space, yes, I think video games are very helpful. I jokingly told my parents that video games were not a waste in my life, that it helps me in how I’m able to help humanity and help patients. But I think that one reminder we have to put at the forefront of this, that’s something that we talk about in the entire innovation space, whether it’s [artificial intelligence (AI)], medical robotics, or others—I sit at a place where we look at all sorts of future-state technology in image-guided medicine for how we impact patients—is it cannot be technology for technology’s sake. Ultimately, at the end of the day, it’s not “video games”, It’s a human being that’s on the other line. We use those skills and are passionate about it and our capabilities, but at the end of the day, it’s how do these things address unmet clinical needs to help move the needle forward for our patients and community. What’s exciting to me is I do think we’re at this critical juncture where this is starting to happen in endovascular robotics quite quickly.

Part 2 of this interview continues with Bercu’s discussion of the technology’s clinical applications in liver and kidney cancer, its implications for reducing operator radiation exposure and physical strain, and its potential for remote, or “telecatheterization,” procedures.

References

1. Robbins R. New robotic tech at Emory offers alternative to surgeries. The Atlanta Journal-Constitution. Updated April 10, 2026. Accessed September 16, 2026. https://tinyurl.com/5haks66r
2. Microbot Medical® receives FDA 510(k) clearance for its LIBERTY® endovascular robotic system. News release. Microbot Medical Inc. September 8, 2025. Accessed September 16, 2026. https://tinyurl.com/bwwp55yz