Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique
Abstract:• CT-guided biopsy is the main procedure to obtain diagnosis in lung tumours. • The robotic device facilitates percutaneous needle placement under CT guidance. • Robot-assisted CT-guided lung biopsy reduces procedure duration and radiation dose.
“…On the other hand, real-time monitoring of lesions movement with CT-fluoroscopy guidance allows reducing needle passes and procedure time; however, the radiation dose (to both the patients and operator) is significant [28]. To simplify the approach and to increase the speed and reliability of step-and-shoot CT-guided chest biopsies, several technical advances have been proposed, including augmented reality and use of robotic platforms [29]. Fig.…”
BackgroundThis article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy.MethodsImaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive.ResultsAlthough a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy.ConclusionPercutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications.Teaching points
• Imaging-guided biopsy is one of the main methods to obtain lung nodule specimens.
• CT has the highest accuracy for diagnosis as an imaging guide.
• Compared to FNAB, CNB has a higher accuracy for diagnosis.
• Pneumothorax and parenchymal pulmonary haemorrhage care the most frequent complications.
• Several clinical and technical variables can affect diagnostic accuracy and patient safety.
“…On the other hand, real-time monitoring of lesions movement with CT-fluoroscopy guidance allows reducing needle passes and procedure time; however, the radiation dose (to both the patients and operator) is significant [28]. To simplify the approach and to increase the speed and reliability of step-and-shoot CT-guided chest biopsies, several technical advances have been proposed, including augmented reality and use of robotic platforms [29]. Fig.…”
BackgroundThis article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy.MethodsImaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive.ResultsAlthough a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy.ConclusionPercutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications.Teaching points
• Imaging-guided biopsy is one of the main methods to obtain lung nodule specimens.
• CT has the highest accuracy for diagnosis as an imaging guide.
• Compared to FNAB, CNB has a higher accuracy for diagnosis.
• Pneumothorax and parenchymal pulmonary haemorrhage care the most frequent complications.
• Several clinical and technical variables can affect diagnostic accuracy and patient safety.
“…133,134,137 Several advanced transthoracic approaches using optical navigation, electromagnetic navigation, and robotics are under investigation; it is still to be determined whether these systems enhance diagnostic rates and reduce complications relative to experienced interventional radiologists. [141][142][143][144]…”
Section: Optimization Of Tissue Sampling Techniquesmentioning
Each year, more than 1 million persons worldwide are found to have a lung nodule that carries a risk of being malignant. In reality, the vast majority of lung nodules are benign, whether identified by screening or incidentally. The consequences of delaying or missing the diagnosis of lung cancer can be substantial, as can be the consequences of invasive procedures on patients with benign lung nodules. The challenge for the clinician caring for these patients is to differentiate between benign and malignant nodules with the least harm possible. In this review, we will discuss management strategies of the indeterminate pulmonary nodule and will review recent advances and harm-reduction strategies.
“…A brief literature review of the state of the art on robot‐assisted puncture research is presented in the following. Anzidei et al compared 100 cases of robot‐assisted percutaneous lung biopsy with conventional percutaneous lung biopsy, and the results showed that the robot group had higher accuracy and safety. Zhao et al studied the robot‐assisted puncture system and analyzed the techniques of modeling, planning, navigation, and control.…”
Background
Robot‐assisted puncture has gradually attracted more attention and practical clinical application. The lesion positioning and the needle positioning are the basis to ensure the accuracy of puncture and the key techniques in insertion operation.
Methods
A lesion positioning method is established which is realized only by the robot‐CT system without using external positioning system, and an omnidirectional needle positioning method is also developed and realized by using VRCM, in order to make the puncture needle always keep pointing to the lesion point. A CT‐guided surgical robotic system used for minimally invasive percutaneous lung is designed and the physical prototype is manufactured, to perform in‐vitro experiments, thereby to validate the effectiveness of the lesion positioning method and the feasibility of omnidirectional needle positioning method.
Results
The accuracy of established lesion positioning method based on three non‐collinear markers is within 3 mm, which is similar to that of the least squares method based on the five non‐coplanar markers, but the positioning efficiency can be improved by about 40%, and the non‐collinearity of markers is easier to be satisfied than non‐coplanarity in practical applications. The average calculation error of the established positioning method is 0.997 mm. Moreover, the omnidirectional positioning of the puncture needle under the designed surgical robot is feasible.
Conclusions
The designed surgical robot has good control accuracy and it can satisfy the requirements for use. The established lesion positioning method can provide a good precision basis for robot‐assisted puncture surgery. The suitable insertion point and insertion posture can be determined by the developed omnidirectional needle positioning method. This study can provide theoretical reference for further study of path planning or autonomous positioning.
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