The 2025 Southern Association for Vascular Surgery (SAVS) presidential address featured the hashtag phrase #OnlyUs, an allusion to the specialty’s “unique” differentiator.
SAVS 2024–25 President Alan Lumsden, MD, returned to a familiar recent theme for his address to the 49th annual meeting of SAVS in St. Thomas, the U.S. Virgin Islands (Jan. 22–25): the topic of robotics in vascular surgery.
The twist this time around was that it was his SAVS presidential address, and he carved his pitch for robotic vascular surgery in bolder terms: digital surgery and robotics will form the third revolution in the specialty in the coming years. Only vascular surgeons are capable of being positioned at the epicenter of open surgery (the first vascular revolution), endovascular intervention (the second) and robotics, he said, “working in that space where we can integrate these things, which I think is going to allow us to be branded differently, to market us differently and will fundamentally differentiate us.”
Lumsden, the medical director of Methodist DeBakey Heart and Vascular Center at Houston Methodist in Houston, Texas, said robotics were the epitome of digital surgery and are “going to change the way we practice.” Referencing the long-running Pumps & Pipes collaboration between Houston industries sparked by a conversation between Lumsden and an oilfield engineer, he told SAVS 2025 that a lot of the solutions to vascular surgery’s problems “exist in somebody else’s toolkit.”
He said, “I submit to you that you’re going to see in the next few years digital surgery and robotics as the third revolution, and I think you’re eminently capable of managing that,” coining the social media phrase #OnlyUs in suggesting only vascular is poised to pull off the feat.
In the case of the endovascular revolution, the empowering technology was real-time imaging, Lumsden explained. “There were headwinds, so the message to younger people is, ‘Don’t always listen to your seniors, they don’t always know exactly what is going on in the future. So challenge what the dogma is.”
Right now, vascular surgery has two products: open surgery and endovascular intervention, the latter of which is not unique to the vascular specialty, Lumsden said. “Have we gone too far with this?” he asked. Open case volumes are diminishing, with advances in technology “that we have been good at embracing having a knock-on effect on our volumes.”
Then there is the competition. Interventional radiologists and, crucially, cardiologists, who are “bigger, better organized—and they can control the patients.”
Displaying a Venn diagram showing the intersecting realms of open surgery, endovascular intervention and robotics, Lumsden stated that “only you and I can play in this pace.” The “secret weapon” at the heart of it are the 100–120 fellows per year who join the specialty with a certificate in robotic surgery. “People like me have traditionally said, ‘Waste of time, I’m never going to use that again.’ We are in the endo world—but so are many others.” Robotic surgery, Lumsden said, offers the prospect of combining the “best long-term therapeutic intervention” of open surgery with a superior delivery system in the form of endovascular intervention. “What if we could actually go back to using some of those principles and apply both, and can we do this?”
Lumsden tackled the difficulty factor. “How hard is this going to be? Not nearly as hard as going from open to endo: we had no pre-existing skillsets [then]; a lot of headwinds from other people who didn’t really want us to do it; the cost for participation was massive; we didn’t have catheters, we didn’t have wires, we didn’t have imaging.” On the other hand, the robots exist, though there are credentialing challenges and costs to consider.
Fundamentally, he said, this is “uniquely differentiating for the vascular surgery community if we can embrace it.” Integrating imaging gave vascular surgery high volume and low risk, with the patient “actually benefiting from the [endovascular] procedure. You need the same thing from robotics in order to be able to scale it up,” he added.
Lumsden’s “ah-ha moments” over the role played by robotics in vascular procedures, only at the hands of other specialists, are well-documented. In that vein, he alluded to the vascular “firemen” concept, in which vascular surgeons come to the aid of other specialties. “Increasingly you and I are not going to have to deal with problems that are being generated unless we learn how to do this,” he said. “A lot of the procedures that we need to incorporate into these robotic training programs already exist. And we have to focus on how we bring this together. The gynecologists are using it; the urologists, the thoracic surgeons are using it; the cardiac surgeons are using it. Need I say more?”
Key to developing a robotic surgery program is identifying who on the team has the largest skillset, and case volume needs to be pushed on to that individual who is able to perform the procedures safely, Lumsden said. “There needs to be graded risk.” A mistake in the robotic world “is leaping to the aorta too early,” he observed. “Gradually increase the skillset,” he said.
The challenge remains that there is no indication for vascular on the existing robot, Lumsden pointed out, citing the need for a database to collect cases with a view to achieving Food and Drug Administration (FDA) approval.
“There are a lot of different tools that we are completely oblivious to but your fellows coming into your programs are well aware of, and that’s the advantage we’ve got,” he added.
Maiden Roger M Greenhalgh Lecture brings robotics into global focus
The World Federation Vascular Societies (WFVS) late last year staged its inaugural Roger M. Greenhalgh Lecture in honor of his work as pioneer in the field of vascular surgery. The memorial lecture took place during the 31st Annual Meeting of the Vascular Society of India in Jaipur, India (Oct. 17–19), and was presented by Lumsden.
Fittingly, the talk focused on the frontier-pushing topic that was also the subject of the SAVS 2025 presidential address: robotic vascular surgery and artificial intelligence.
Like Greenhalgh, Lumsden hails from the United Kingdom and is known for pushing the envelope in the field of vascular surgery. Lumsden’s team at Houston Methodist DeBakey Heart & Vascular Center is at the vanguard of efforts to bring robotics into the vascular surgical space.
In the lecture, entitled “Robotics and AI: Next revolution in vascular surgery,” the chair of cardiovascular surgery outlined a roadmap for bringing robotic vascular surgery into the fold of clinical practice.
Lumsden referenced his moment of clarity around the concept, how he realized major vascular operations were being handled robotically by other specialties, and how vascular surgery must not miss the boat.
He looked at ways of evaluating feasibility; selecting faculty with the necessary skillset to carry out robotic procedures; mitigating risk in getting teams up to speed; identifying high-frequency, low-risk procedures; expanding the pool of procedures that can be performed; using training resources to test in cadavers; and obtaining Food and Drug Administration (FDA) approval in order to obtain a vascular indication.
Lumsden cast robotic vascular surgery against the current treatment landscape of open surgery versus endovascular intervention. With open surgery, he said, the core therapeutic component is both “excellent and proven”, while the delivery system—via open exposure—is “unacceptable.” Endovascular treatment, on the other hand, bears an “excellent”, minimally invasive delivery system, but a “less durable” core therapeutic component. The question becomes, he said, whether robotics can provide an excellent delivery system while retaining an excellent core therapeutic component.
