Needle-like instruments for steering through solid organs: A review of the scientific and patent literature

Abstract

High accuracy and precision in reaching target locations inside the human body is necessary for the success of percutaneous procedures, such as tissue sample removal (biopsy), brachytherapy, and localized drug delivery. Flexible steerable needles may allow the surgeon to reach targets deep inside solid organs while avoiding sensitive structures (e.g. blood vessels). This article provides a systematic classification of possible mechanical solutions for three-dimensional steering through solid organs. A scientific and patent literature search of steerable instrument designs was conducted using Scopus and Web of Science Derwent Innovations Index patent database, respectively. First, we distinguished between mechanisms in which deflection is induced by the pre-defined shape of the instrument versus mechanisms in which an actuator changes the deflection angle of the instrument on demand. Second, we distinguished between mechanisms deflecting in one versus two planes. The combination of deflection method and number of deflection planes led to eight logically derived mechanical solutions for three-dimensional steering, of which one was dismissed because it was considered meaningless. Next, we classified the instrument designs retrieved from the scientific and patent literature into the identified solutions. We found papers and patents describing instrument designs for six of the seven solutions. We did not find papers or patents describing instruments that steer in one-plane on-demand via an actuator and in a perpendicular plane with a pre-defined deflection angle via a bevel tip or a pre-curved configuration.

Wasp-Inspired Needle Insertion with Low Net Push Force

“…Some of these newly developed needles rely on concentric axial insertion of multiple pre-bent needle parts, whereas others rely on reaction forces from the tissue to control the steering curvature (for reviews see [10,11]). One drawback of flexible needles is that the axial load applied at the back of a needle increases with resistive forces on the needle tip and shaft when penetrating deeper into the tissue.…”

Functional principles of steerable multi‐element probes in insects

“…Needles based on insect probes may help to solve the challenges of minimisation, buckling, and steering. Development of multi-element needles capable of adjusting their tip asymmetry is already underway Leibinger et al, 2016;Scali et al, 2017). Inserting such needles using reciprocal motion of elements decreases tissue strain and net insertion forces that might lead to tearing and damage (Leibinger et al, 2016;Parittotokkaporn et al, 2010).…”

Data-Driven Detection of Needle Buckling Events in Robotic Needle Steering

“…These methods can be used to address needle buckling outside the patient tissue. To avoid buckling within tissue, several novel needle designs have been proposed to increase the critical buckling force of the needle, or reduce the insertion force on the needle during insertion into tissue [31][32][33][34][35][36]. These methods also rely on needle-tissue biomechanics properties, and thus may not be as effective for real-time avoidance control of buckling events due to uncertainties of the tissue mechanics properties or underlying internal tissue structure.…”