Robotic assistance for percutaneous needle insertion in the kidney: preclinical proof on a swine animal model

Abstract

Background We evaluated the accuracy, safety, and feasibility of a computed tomography (CT)-guided robotic assistance system for percutaneous needle placement in the kidney. Methods Fiducials surgically implanted into the kidneys of two pigs were used as targets for subsequent robotically-assisted needle insertion. Robotically-assisted needle insertions and CT acquisitions were coordinated using respiratory monitoring. An initial scan volume data set was used for needle insertion planning defining skin entry and target point. Then, needle insertion was performed according to robot positioning. The accuracy of needle placement was evaluated upon the distance between the needle tip and the predefined target on a post needle insertion scan. A delayed contrast-enhanced CT scan was acquired to assess safety. Results Eight needle trajectories were performed with a median procedural time measured from turning on the robotic system to post needle insertion CT scan of 21 min (interquartile range 15.5−26.5 min). Blind review of needle placement accuracy was 2.3 ± 1.2 mm (mean ± standard deviation) in lateral deviation, 0.7 ± 1.7 mm in depth deviation, and 2.8 ± 1.3 mm in three-dimensional Euclidian deviation. All needles were inserted on the first attempt, which determined 100% feasibility, without needle readjustment. The angulation and length of the trajectory did not impact on the needle placement accuracy. Two minor procedure-related complications were encountered: 2 subcapsular haematomas (13 × 6 mm and 35 × 6 mm) in the same animal. Conclusions Robotically-assisted needle insertion was shown feasible, safe and accurate in a swine kidney model. Further larger studies are needed.

Evaluation of a New CT-Guided Robotic System for Percutaneous Needle Insertion for Thermal Ablation of Liver Tumors: A Prospective Pilot Study

“…No adverse events were reported in this study in relation with the use of the device, confirming the safety data collected in animal pre-clinical studies [ 11 , 12 ]. Only few other devices are available for robotic needle placements, and no specific complications were reported in prospective clinical investigations involving these devices [ 3 , 7 , 17 – 19 ].…”

“…The EPIONE robotic system (Quantum Surgical, Montpellier, France) (Fig. 2 ) was already detailed in previous animal studies [ 11 , 12 ]. It is composed of a mobile display cart (workstation), a mobile navigation cart (infra-red camera), a mobile robot cart (robot arm) on which is attached a needle guide , and a patient reference attached to the patient’s skin.…”

Bridging the simulation-to-real gap for AI-based needle and target detection in robot-assisted ultrasound-guided interventions

“…Interventional radiology has been credited with a variety of benefits such as reduced recovery times, reduced rates and severity of post-surgical complications, higher patient acceptance rates, and higher cost efficiency [ 1 ]. Recently, robot-assisted, interventional radiology has been on the rise [ 2 – 4 ]. While many different devices for different applications exist [ 5 ], almost all robotic systems available for clinical use today are teleoperators or assistants for holding and aiming [ 6 ].…”

Current State of Robotics in Interventional Radiology

“…Similarly, the robot was used in CT-guided percutaneous needle insertion targeting a total of eight fiducial targets placed in the kidneys of two swine. All needle insertions successfully reached the target on the first attempt with no need for readjustment; however, there were two subcapsular haematomas which did not progress to retroperitoneal effusions [ 62 ]. In a recent prospective study, the EPIONE robotic system was used for robotic-assisted thermal ablation of liver tumours [ 60 ].…”