Use of a steerable needle for CT-guided nerve plexus blockade

Steerable needles for radio-frequency ablation in cirrhotic livers

Accurate needle placement in deep-seated liver tumours can be difficult. In this work, we disclose two new manually controlled steerable needles for 17G radio-frequency ablation probe placement. The needles contain stylets with embedded compliant joints for active tip articulations, and concentric tubes for (curved-path) guidance. Needle steering was evaluated sequentially by intended users and in intended-use tissue types. Six interventional radiologists evaluated the needle in repeated ultrasound-guided steering tasks in liver-mimicking phantoms. Targets were located at a 100 mm depth and 20 mm lateral offset from the initial insertion line. The resulting mean absolute tip placement error was 1.0 ± 1.0 mm. Subsequently, steering-induced tissue damage was evaluated in fresh cirrhotic human liver explants. The surface area of puncture holes was estimated in scanned histology slides, using a connected-components analysis. The mean surface area was 0.26 ± 0.16 mm² after steering with a median radius of curvature of 0.7 × 10³ mm, versus 0.35 ± 0.15 mm² after straight-path insertions with the steerable needle and 0.15 ± 0.09 mm² after straight-path RFA probe insertions. The steering mechanisms proposed enable clinically relevant path corrections for 17G needles. Radiologists were quickly adept in curved-path RFA probe placement and the evaluation of histological tissue damage demonstrated a potentially safe use during liver interventions.

Design of an ultra-thin steerable probe for percutaneous interventions and preliminary evaluation in a gelatine phantom

Needles with diameter under 1 mm are used in various medical applications to limit the risk of complication and patient discomfort during the procedure. Next to a small diameter, needle steerability is an important property for reaching targets located deep inside the body accurately and precisely. In this paper, we present a 0.5-mm prototype probe which is able to steer in three dimensions (3D) without the need of axial rotation. The prototype consists of three Nitinol wires (each with a diameter of 0.125 mm) with a pre-curved tip. The wires are kept together by a stainless steel tube. Each wire is clamped to a block which translates along a leadscrew, the rotation of the latter being controlled by a wheel connected at the distal end of the leadscrew. The tip bends upon retraction of one or two wires. When pushed through a soft solid structure (e.g., a soft tissue or soft tissue phantom), the probe deflects due to off-axis forces acting on its tip by the surrounding structure. We tested the performance of the prototype into a 10% wt gelatine phantom, in terms of the predictability of the steering direction and the controllability of the final position after steering inside the substrate. The results showed that the probe steered in the direction of the retracted wire and that the final position varied from small deflections from the straight path when the wires were slightly retracted, to sharp curvatures for large wire retraction. The probe could be used in various applications, from cases where only a small correction of the path in one direction is needed to cases where the path to be followed includes obstacles and curves in multiple directions.