Starting CT-guided robotic interventional oncology at a UK centre

Abstract

Objectives: A commercially available CT guided robot offers enhanced abilities in planning, targeting, and confirming accurate needle placement. In this short communication, we describe our first UK experience of robotic Interventional Oncology procedures. Methods: We describe the device, discuss installation, operation, and report upon needle insertion success, accuracy (path deviation; PD and tip deviation; TD), number of adjustments, complications, and procedural success. Results: Nine patients (seven males), median age 66 years (range 43–79) were consented for biopsy or ablation between March and April 2021. Needle placement in biopsy was more accurate than ablation (1 vs 11 mm PD and 1 vs 20 mm TD) and required fewer adjustments (median 0 vs 5). No complications arose, and all procedures were successful (diagnostic material obtained or complete ablation at follow up). Conclusions: Short procedure times and very high levels of accuracy were readily achieved with biopsy procedures, although tumour ablation was less accurate which likely reflects higher procedural complexity. Advances in knowledge: Achieving highly accurate robotic biopsy with is feasible within a very short time span. Further work is required to maximise the potential of robotic guidance in tumour ablation procedures, which is likely due to higher complexity giving a longer learning curve.

Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation

“…It is easy to choose a puncture route out of the axial plane, for instance, with a caudo-cranial angulation, and even lesions high in the liver dome can be reached without traversing the lung or other non-target structures. This C-arm guidance is already installed on many angiography systems, obviating the need for expensive and often complex robotic systems [ 8 – 10 ]. A downside of this technique is that it requires fluoroscopy while the operator is placing the antenna, resulting in radiation exposure.…”

Developing and testing a robotic MRI/CT fusion biopsy technique using a purpose-built interventional phantom

“…Further work regarding phantom development could include reproduction at other centres, use for in-gantry biopsy and three-dimensional printing patient-specific phantoms [ 20 ]. Clinical translation should include the addition of a vacuum immobilisation mattress to reduce external motion [ 21 ]. We also advise taking a stepwise approach, where relatively fixed tumours are first investigated ( e.g.…”

“…Further work regarding phantom development could include reproduction at other centres, use for in-gantry biopsy and three-dimensional printing patient-specific phantoms [20]. Clinical translation should include the addition of a vacuum immobilisation mattress to reduce external motion [21]. We also advise taking a stepwise approach, where relatively fixed tumours are first investigated (e.g., MRI-guided bone biopsy [22,23], followed by more mobile tumours using internal motion correction techniques as has been applied in robotic lung biopsy without image fusion using breath hold monitoring [24].…”

Robotic versus freehand CT-guided radiofrequency ablation of pulmonary metastases: a comparative cohort study

“…Our team comprised (i) a minimum of one board certified Consultant Interventional Radiologist from a group of four, who performed procedures (EJ, 4 years’ experience, and NK 14 years’ experience, JMC, 19 years’ experience and NF, 17 years’ experience of lung RFA), (ii) two Radiographers who acquired images, operated the CT scanner and RF generator (iii) a Consultant Anesthetist and Anesthetic assistant who delivered the anesthetic (iv) a Nurse who cared for the patient and provided equipment. Our initial experience with robotic procedures has been reported previously [ 15 ]. We had performed 22 robotic procedures in total (7 biopsies, 15 liver ablations) before attempting robotic lung RFA.…”

“…Our group has recently started a practice in robotic interventions for biopsy and ablation procedures [ 15 ]. The purpose of this study is to determine the feasibility, safety, and targeting accuracy of robotic RFA for pulmonary metastases with high frequency jet ventilation.…”