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Frühling P, Stillström D, Holmquist F, Nilsson A, Freedman J. Change in tissue resistance after irreversible electroporation in liver tumors as an indicator of treatment success - A multi-center analysis with long term follow-up. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108508. [PMID: 38950490 DOI: 10.1016/j.ejso.2024.108508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/03/2024] [Accepted: 06/22/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION A nationwide multicenter study was performed to examine whether there is a correlation between decrease in tissue resistance and time to local tumor recurrence after irreversible electroporation (IRE) in patients with hepatocellular carcinoma (HCC) and colorectal cancer liver metastases (CRCLM). METHODS All patients treated with IRE for liver tumors in Sweden from 2011 until 2018 were included. Patient characteristics and recurrence patterns were obtained from medical records and radiological imaging. All procedural data from the IRE hardware at the three hospitals performing IRE were retrieved. The resistance during each pulse and the change during each treatment were calculated. The electrode pair with the smallest decrease in tissue resistance was used and compared with the time to LTP. RESULTS 149 patients with 206 tumors were treated. Exclusion due to missing and inaccurate data resulted in 124 patients with 170 tumors for the analyses. In a multivariable Cox regression model, a smaller decrease in tissue resistance and larger tumor size were associated with shorter time to local tumor recurrence for CRCLM, but not for HCC. CONCLUSION There was an association between a decrease in tissue resistance and time to local tumor recurrence for CRCLM. The decrease in resistance, in combination with a rise in current, may be the parameters the interventionist should use during IRE to decide if the treatment is successful.
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Affiliation(s)
- Petter Frühling
- Department of Surgical Sciences, Uppsala University, Uppsala Sweden.
| | - David Stillström
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Fredrik Holmquist
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Anders Nilsson
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
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Bodard S, Guinebert S, Dimopoulos PM, Tacher V, Cornelis FH. Contribution and advances of robotics in percutaneous oncological interventional radiology. Bull Cancer 2024:S0007-4551(24)00263-7. [PMID: 39198085 DOI: 10.1016/j.bulcan.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 09/01/2024]
Abstract
The advent of robotic systems in interventional radiology marks a significant evolution in minimally invasive medical procedures, offering enhanced precision, safety, and efficiency. This review comprehensively analyzes the current state and applications of robotic system usage in interventional radiology, which can be particularly helpful for complex procedures and in challenging anatomical regions. Robotic systems can improve the accuracy of interventions like microwave ablation, radiofrequency ablation, and irreversible electroporation. Indeed, studies have shown a notable decrease of an average 30% in the mean deviation of probes, and a 40% lesser need for adjustments during interventions carried out with robotic assistance. Moreover, this review highlights a 35% reduction in radiation dose and a stable-to-30% reduction in operating time associated with robot-assisted procedures compared to manual methods. Additionally, the potential of robotic systems to standardize procedures and minimize complications is discussed, along with the challenges they pose, such as setup duration, organ movement, and a lack of tactile feedback. Despite these advancements, the field still grapples with a dearth of randomized controlled trials, which underscores the need for more robust evidence to validate the efficacy and safety of robotic system usage in interventional radiology.
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Affiliation(s)
- Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Necker Hospital, University of Paris-Cité, 149 rue de Sèvres, 75015 Paris, France; CNRS UMR 7371, Inserm U 1146, laboratoire d'imagerie biomédicale, Sorbonne University, 75006 Paris, France.
| | - Sylvain Guinebert
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Platon M Dimopoulos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Interventional Radiodolgy Dpt, University Hospital of Patras with memorial, 26504 Rio, Greece
| | - Vania Tacher
- Unité Inserm U955 n(o) 18, service d'imagerie médicale, hôpital Henri-Mondor, université Paris-Est, AP-HP, Créteil, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Scharll Y, Radojicic N, Laimer G, Schullian P, Bale R. Robot-Assisted 2D Fluoroscopic Needle Placement-A Phantom Study. Diagnostics (Basel) 2024; 14:1723. [PMID: 39202211 PMCID: PMC11354198 DOI: 10.3390/diagnostics14161723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
RATIONALE AND OBJECTIVES To evaluate the targeting accuracy of a novel robot-assisted guidance technique relying on one pair of 2D C-arm images. MATERIAL AND METHODS In total, 160 punctures were carried out semi-automatically by using a novel robotic device. The needle's paths were planned based on one pair of 2D fluoroscopic images from different angles. Conically shaped aluminum tips inside a gelatin-filled plexiglass phantom served as targets. The accuracy of the needle placement was assessed by taking control CTs and measuring the Euclidean distance (ED) and normal distance (ND) between the needle and the target point. In addition, the procedural time per needle placement was evaluated. RESULTS The accomplished mean NDs at the target for the 45°, 60°, 75° and 90° angles were 1.86 mm (SD ± 0.19), 2.68 mm (SD ± 0.18), 2.19 mm (SD ± 0.18) and 1.86 mm (SD ± 0.18), respectively. The corresponding mean EDs were 2.32 mm (SD ± 0.16), 2.68 mm (SD ± 0.18), 2.65 mm (SD ± 0.16) and 2.44 mm (SD ± 0.15). The mean duration of the total procedure, including image acquisition, trajectory planning and placement of four needles sequentially, was 12.7 min. CONCLUSIONS Robotic guidance based on two 2D fluoroscopy images allows for the precise placement of needle-like instruments at the first attempt without the need for using an invasive dynamic reference frame. This novel approach seems to be a valuable tool for the precise targeting of various anatomical structures that can be identified in fluoroscopic images.
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Affiliation(s)
| | | | | | | | - Reto Bale
- Interventional Oncology-Stereotaxy & Robotics (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Scharll Y, Radojicic N, Laimer G, Schullian P, Bale R. Puncture Accuracy of Robot-Assisted CT-Based Punctures in Interventional Radiology: An Ex Vivo Study. Diagnostics (Basel) 2024; 14:1371. [PMID: 39001261 PMCID: PMC11241553 DOI: 10.3390/diagnostics14131371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES The purpose of this study was to assess the performance of an optically tracked robot for computed-tomography (CT)-guided needle placements in a phantom study. METHODS In total, 240 needle punctures were carried out with the help of an optically tracked robotic device (Micromate) based on CT image datasets at three different slice thicknesses (1, 3, and 5 mm). Conically shaped targets inside a gelatin-filled plexiglass phantom were punctured. The target positioning error between the planned and actual needle trajectory was assessed by measuring the lateral positioning error (ND) between the target and the puncture needle and the Euclidean distance (ED) between the needle tip and target in control CTs. RESULTS The mean ND and ED for the thinnest CT slice thickness were 1.34 mm (SD ± 0.82) and 2.1 mm (SD ± 0.75), respectively. There was no significant impact of target depth on targeting accuracy for ND (p = 0.094) or ED (p = 0.187). The mean duration for the planning of one trajectory and for needle positioning were 42 s (SD ± 4) and 64 s (SD ± 7), respectively. CONCLUSIONS In this ex vivo study, the robotic targeting device yielded satisfactory accuracy results at CT slice thicknesses of 1 and 3 mm. This technology may be particularly useful in interventions where the accurate placement of needle-like instruments is required.
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Affiliation(s)
| | | | | | | | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Uribe Rivera AK, Seeliger B, Goffin L, García-Vázquez A, Mutter D, Giménez ME. Robotic Assistance in Percutaneous Liver Ablation Therapies: A Systematic Review and Meta-Analysis. ANNALS OF SURGERY OPEN 2024; 5:e406. [PMID: 38911657 PMCID: PMC11191991 DOI: 10.1097/as9.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/19/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The aim of this systematic review and meta-analysis is to identify current robotic assistance systems for percutaneous liver ablations, compare approaches, and determine how to achieve standardization of procedural concepts for optimized ablation outcomes. Background Image-guided surgical approaches are increasingly common. Assistance by navigation and robotic systems allows to optimize procedural accuracy, with the aim to consistently obtain adequate ablation volumes. Methods Several databases (PubMed/MEDLINE, ProQuest, Science Direct, Research Rabbit, and IEEE Xplore) were systematically searched for robotic preclinical and clinical percutaneous liver ablation studies, and relevant original manuscripts were included according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. The endpoints were the type of device, insertion technique (freehand or robotic), planning, execution, and confirmation of the procedure. A meta-analysis was performed, including comparative studies of freehand and robotic techniques in terms of radiation dose, accuracy, and Euclidean error. Results The inclusion criteria were met by 33/755 studies. There were 24 robotic devices reported for percutaneous liver surgery. The most used were the MAXIO robot (8/33; 24.2%), Zerobot, and AcuBot (each 2/33, 6.1%). The most common tracking system was optical (25/33, 75.8%). In the meta-analysis, the robotic approach was superior to the freehand technique in terms of individual radiation (0.5582, 95% confidence interval [CI] = 0.0167-1.0996, dose-length product range 79-2216 mGy.cm), accuracy (0.6260, 95% CI = 0.1423-1.1097), and Euclidean error (0.8189, 95% CI = -0.1020 to 1.7399). Conclusions Robotic assistance in percutaneous ablation for liver tumors achieves superior results and reduces errors compared with manual applicator insertion. Standardization of concepts and reporting is necessary and suggested to facilitate the comparison of the different parameters used to measure liver ablation results. The increasing use of image-guided surgery has encouraged robotic assistance for percutaneous liver ablations. This systematic review analyzed 33 studies and identified 24 robotic devices, with optical tracking prevailing. The meta-analysis favored robotic assessment, showing increased accuracy and reduced errors compared with freehand technique, emphasizing the need for conceptual standardization.
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Affiliation(s)
- Ana K Uribe Rivera
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Barbara Seeliger
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Visceral and Digestive Surgery, University Hospitals of Strasbourg, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube, UMR 7357 CNRS, INSERM U1328 RODIN, University of Strasbourg, Strasbourg, France
- Inserm U1110, Institute for Viral and Liver Diseases, Strasbourg. France
- Trustworthy AI Lab, Centre National de la Recherche Scientifique (CNRS), France
| | - Laurent Goffin
- ICube, UMR 7357 CNRS, INSERM U1328 RODIN, University of Strasbourg, Strasbourg, France
- Trustworthy AI Lab, Centre National de la Recherche Scientifique (CNRS), France
- Computational Surgery SAS, Schiltigheim, France
| | | | - Didier Mutter
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Visceral and Digestive Surgery, University Hospitals of Strasbourg, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Mariano E Giménez
- From the IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- DAICIM Foundation (Training, Research and Clinical Activity in Minimally Invasive Surgery), Buenos Aires, Argentina
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Bodard S, Guinebert S, Petre EN, Alexander E, Marinelli B, Sarkar D, Cornelis FH. Percutaneous Lung Biopsies With Robotic Systems: A Systematic Review of Available Clinical Solutions. Can Assoc Radiol J 2024:8465371241242758. [PMID: 38581355 DOI: 10.1177/08465371241242758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
Objectives: This systematic review aims to assess existing research concerning the use of robotic systems to execute percutaneous lung biopsy. Methods: A systematic review was performed and identified 4 studies involving robotic systems used for lung biopsy. Outcomes assessed were operation time, radiation dose to patients and operators, technical success rate, diagnostic yield, and complication rate. Results: One hundred and thirteen robot-guided percutaneous lung biopsies were included. Technical success and diagnostic yield were close to 100%, comparable to manual procedures. Technical accuracy, illustrated by needle positioning, showed less frequent needle adjustments in robotic guidance than in manual guidance (P < .001): 2.7 ± 2.6 (range 1-4) versus 6 ± 4 (range 2-12). Procedure time ranged from comparable to reduced by 35% on average (20.1 ± 11.3 minutes vs 31.4 ± 10.2 minutes, P = .001) compared to manual procedures. Patient irradiation ranged from comparable to reduced by an average of 40% (324 ± 114.5 mGy vs 541.2 ± 446.8 mGy, P = .001). There was no significant difference in reported complications between manual biopsy and biopsies that utilized robotic guidance. Conclusion: Robotic systems demonstrate promising results for percutaneous lung biopsy. These devices provide adequate accuracy in probe placement and could both reduce procedural duration and mitigate radiation exposure to patients and practitioners. However, this review underscores the need for larger, controlled trials to validate and extend these findings.
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Affiliation(s)
- Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, University of Paris Cité, Necker Hospital, Paris, France
- Laboratoire d'Imagerie Biomédicale, Sorbonne University, CNRS UMR 7371, INSERM U 1146, Paris, France
| | - Sylvain Guinebert
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erica Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debkumar Sarkar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Sorbonne University, Tenon Hospital, Paris, France
- Weill Cornell Medical College, New York, NY, USA
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7
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Matsui Y, Kamegawa T, Tomita K, Uka M, Umakoshi N, Kawabata T, Munetomo K, Iguchi T, Matsuno T, Hiraki T. Robotic systems in interventional oncology: a narrative review of the current status. Int J Clin Oncol 2024; 29:81-88. [PMID: 37115426 DOI: 10.1007/s10147-023-02344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Interventional oncology offers minimally invasive treatments for malignant tumors for curative and palliative purposes based on the percutaneous insertion of needles or catheters into the target location under image guidance. Robotic systems have been gaining increasing attention as tools that provide potential advantages for image-guided interventions. Among the robotic systems developed for intervention, those relevant to the oncology field are mainly those for guiding or driving the needles in non-vascular interventional procedures such as biopsy and tumor ablation. Needle-guiding robots support planning the needle path and align the needle robotically according to the planned trajectory, which is combined with subsequent manual needle insertion by the physician through the needle guide. Needle-driving robots can advance the needle robotically after determining its orientation. Although a wide variety of robotic systems have been developed, only a limited number of these systems have reached the clinical phase or commercialization thus far. The results of previous studies suggest that such interventional robots have the potential to increase the accuracy of needle placement, facilitate out-of-plane needle insertion, decrease the learning curve, and reduce radiation exposure. On the other hand, increased complexity and costs may be a concern when using robotic systems compared with conventional manual procedures. Further data should be collected to comprehensively assess the value of robotic systems in interventional oncology.
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Affiliation(s)
- Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Tetsushi Kamegawa
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | - Takayuki Matsuno
- Faculty of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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Charalampopoulos G, Bale R, Filippiadis D, Odisio BC, Wood B, Solbiati L. Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap. Diagnostics (Basel) 2023; 14:98. [PMID: 38201407 PMCID: PMC10795729 DOI: 10.3390/diagnostics14010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Interventional oncology (IO) is the field of Interventional Radiology that provides minimally invasive procedures under imaging guidance for the diagnosis and treatment of malignant tumors. Sophisticated devices can be utilized to increase standardization, accuracy, outcomes, and "repeatability" in performing percutaneous Interventional Oncology techniques. These technologies can reduce variability, reduce human error, and outperform human hand-to-eye coordination and spatial relations, thus potentially normalizing an otherwise broad diversity of IO techniques, impacting simulation, training, navigation, outcomes, and performance, as well as verification of desired minimum ablation margin or other measures of successful procedures. Stereotactic navigation and robotic systems may yield specific advantages, such as the potential to reduce procedure duration and ionizing radiation exposure during the procedure and, at the same time, increase accuracy. Enhanced accuracy, in turn, is linked to improved outcomes in many clinical scenarios. The present review focuses on the current role of percutaneous navigation systems and robotics in diagnostic and therapeutic Interventional Oncology procedures. The currently available alternatives are presented, including their potential impact on clinical practice as reflected in the peer-reviewed medical literature. A review of such data may inform wiser investment of time and resources toward the most impactful IR/IO applications of robotics and navigation to both standardize and address unmet clinical needs.
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Affiliation(s)
- Georgios Charalampopoulos
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bradford Wood
- Interventional Radiology and Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Luigi Solbiati
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano (Milano), Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milano), 20072 Milano, Italy;
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Bodard S, Guinebert S, N. Petre E, Marinelli B, Sarkar D, Barral M, H Cornelis F. Percutaneous liver interventions with robotic systems: a systematic review of available clinical solutions. Br J Radiol 2023; 96:20230620. [PMID: 37873927 PMCID: PMC10646656 DOI: 10.1259/bjr.20230620] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Robotic-guided interventions are emerging techniques that are gradually becoming a common tool for performing biopsies and tumor ablations in liver. This systematic review aims to evaluate their advancements, challenges, and outcomes. METHODS A systematic review was conducted using the PubMed database to identify relevant articles published between January 2000 and February 2023. Inclusion criteria focused on studies that assessed robotic systems for percutaneous liver biopsies and tumor ablations. Data extraction was performed to collect information on study characteristics; robotic systems; components and software; imaging modality; degree of freedom; and needle insertion methods. The outcome measures analyzed were procedure time, radiation dose, and accuracy. RESULTS 10 studies met the inclusion criteria. The robotic devices used included MAXIO, EPIONE, ROBIO-EX, AcuBot, and ACE robotic systems. The data set consisted of 429 percutaneous thermal ablations and 57 biopsies, both robot-guided. On average, the mean deviation of probes was reduced by 30% (from 1.6 vs 3.3 mm to 2.4 vs 3.9 mm (p < 0.001)), and 40% (p < 0.05) fewer readjustments were required during the robotic-assisted interventions. Moreover, robotic systems contributed to a reduction in operating time, ranging from 15% (18.3 vs 21.7 min, p < 0.001) to 25% (63.5 vs 87.4 min, p < 0.001). Finally, the radiation dose delivered to both the patient and the operator was decreased by an average of 50% (p < 0.05) compared to manual procedures. ADVANCES IN KNOWLEDGE Robotic systems could provide precise navigation and guidance during liver biopsies and percutaneous ablations.
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Affiliation(s)
| | - Sylvain Guinebert
- Department of Radiology, University of Paris Cité, Necker Hospital, Paris, France
| | - Elena N. Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Debkumar Sarkar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Matthias Barral
- Department of Radiology, Sorbonne University, Tenon Hospital, Paris, France
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Wade R, South E, Anwer S, Sharif-Hurst S, Harden M, Fulbright H, Hodgson R, Dias S, Simmonds M, Rowe I, Thornton P, Eastwood A. Ablative and non-surgical therapies for early and very early hepatocellular carcinoma: a systematic review and network meta-analysis. Health Technol Assess 2023; 27:1-172. [PMID: 38149643 PMCID: PMC11017143 DOI: 10.3310/gk5221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background A wide range of ablative and non-surgical therapies are available for treating small hepatocellular carcinoma in patients with very early or early-stage disease and preserved liver function. Objective To review and compare the effectiveness of all current ablative and non-surgical therapies for patients with small hepatocellular carcinoma (≤ 3 cm). Design Systematic review and network meta-analysis. Data sources Nine databases (March 2021), two trial registries (April 2021) and reference lists of relevant systematic reviews. Review methods Eligible studies were randomised controlled trials of ablative and non-surgical therapies, versus any comparator, for small hepatocellular carcinoma. Randomised controlled trials were quality assessed using the Cochrane Risk of Bias 2 tool and mapped. The comparative effectiveness of therapies was assessed using network meta-analysis. A threshold analysis was used to identify which comparisons were sensitive to potential changes in the evidence. Where comparisons based on randomised controlled trial evidence were not robust or no randomised controlled trials were identified, a targeted systematic review of non-randomised, prospective comparative studies provided additional data for repeat network meta-analysis and threshold analysis. The feasibility of undertaking economic modelling was explored. A workshop with patients and clinicians was held to discuss the findings and identify key priorities for future research. Results Thirty-seven randomised controlled trials (with over 3700 relevant patients) were included in the review. The majority were conducted in China or Japan and most had a high risk of bias or some risk of bias concerns. The results of the network meta-analysis were uncertain for most comparisons. There was evidence that percutaneous ethanol injection is inferior to radiofrequency ablation for overall survival (hazard ratio 1.45, 95% credible interval 1.16 to 1.82), progression-free survival (hazard ratio 1.36, 95% credible interval 1.11 to 1.67), overall recurrence (relative risk 1.19, 95% credible interval 1.02 to 1.39) and local recurrence (relative risk 1.80, 95% credible interval 1.19 to 2.71). Percutaneous acid injection was also inferior to radiofrequency ablation for progression-free survival (hazard ratio 1.63, 95% credible interval 1.05 to 2.51). Threshold analysis showed that further evidence could plausibly change the result for some comparisons. Fourteen eligible non-randomised studies were identified (n ≥ 2316); twelve had a high risk of bias so were not included in updated network meta-analyses. Additional non-randomised data, made available by a clinical advisor, were also included (n = 303). There remained a high level of uncertainty in treatment rankings after the network meta-analyses were updated. However, the updated analyses suggested that microwave ablation and resection are superior to percutaneous ethanol injection and percutaneous acid injection for some outcomes. Further research on stereotactic ablative radiotherapy was recommended at the workshop, although it is only appropriate for certain patient subgroups, limiting opportunities for adequately powered trials. Limitations Many studies were small and of poor quality. No comparative studies were found for some therapies. Conclusions The existing evidence base has limitations; the uptake of specific ablative therapies in the United Kingdom appears to be based more on technological advancements and ease of use than strong evidence of clinical effectiveness. However, there is evidence that percutaneous ethanol injection and percutaneous acid injection are inferior to radiofrequency ablation, microwave ablation and resection. Study registration PROSPERO CRD42020221357. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme (NIHR award ref: NIHR131224) and is published in full in Health Technology Assessment; Vol. 27, No. 29. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ros Wade
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Emily South
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Sumayya Anwer
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Sahar Sharif-Hurst
- Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Melissa Harden
- Information Specialist, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Helen Fulbright
- Information Specialist, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Robert Hodgson
- Senior Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Sofia Dias
- Professor in Health Technology Assessment, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Mark Simmonds
- Senior Research Fellow, Centre for Reviews and Dissemination, University of York, Heslington, UK
| | - Ian Rowe
- Honorary Consultant Hepatologist, Leeds Teaching Hospitals NHS Trust
| | | | - Alison Eastwood
- Professor of Research, Centre for Reviews and Dissemination, University of York, Heslington, UK
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11
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You X, Huang B, Chen J, Lin Z. Application of respiratory sensing technique in CT-guided radiofrequency ablation of liver malignancies. J Cancer Res Ther 2023; 19:1019-1023. [PMID: 37675731 DOI: 10.4103/jcrt.jcrt_303_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Objective This study aimed to examine the effectiveness and safety of respiratory sensing methods in nonvascular interventional therapy of liver tumors. Materials and Methods In this study, 64 patients with primary liver cancer or liver metastasis were retrospectively analyzed. According to two widely used clinical techniques to limit respiratory movement-breath holding and respiratory sensing technology-they were randomly allocated into two groups: respiratory gated and respiratory training. We aimed to compare the application and effect of these two techniques in the nonvascular interventional therapy of liver tumors. Results The puncture times of the respiratory-gated and respiratory training groups were 5.34 ± 2.47 and 8.41 ± 3.63 min, respectively. Puncture errors were 10.00 ± 2.65 and 12.81 ± 8.57 mm, respectively. Puncture adjustment times were 3.06 ± 1.26 and 4.87 ± 1.69 times, respectively, and the differences were statistically significant (P < 0.01). Conclusions Respiratory sensing technology has been effectively used to assist in puncturing liver malignant tumors using a radiofrequency (RF) ablation (RFA) system that is guided by computed tomography (CT) scans. It is superior to the classical breath-holding step puncture technique in terms of puncture time, puncture error, and puncture needle adjustment times.
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Affiliation(s)
- Xiang You
- Department of Interventional Radiology, The First Affiliated Hospital; Department of Interventional Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Bingyu Huang
- Department of Interventional Radiology, The First Affiliated Hospital; Department of Interventional Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jin Chen
- Department of Interventional Radiology, The First Affiliated Hospital; Department of Interventional Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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12
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Zhang Y, Wang MY, Wang LK, Zhang S, Sun H, Liu J. Preliminary study of 3D printing technology for extracorporeal positioning guide assisted ultrasound-guided microwave ablation of the liver. Expert Rev Med Devices 2023; 20:1227-1233. [PMID: 37897059 DOI: 10.1080/17434440.2023.2277233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND We designed a 3D-printed extracorporeal positioning guide for assisting ultrasound-guided microwave ablation of the liver and observed its effectiveness. RESEARCH DESIGN AND METHODS 13 patients with liver cancer were selected, and their CT data were obtained. The CT data is reconstructed in 3D by computer software Mimics to create a 3D model. The 3D-printed in vitro positioning guides were designed by 3-Matic and fabricated using 3D printing technology. Finally, it is applied to the clinic, and its effect is observed. RESULTS The preliminary design of a 3D printed extracorporeal positioning guide was applied to the clinic, and the efficiency of assisted ultrasound positioning was 76.92% (10/13), with three patients requiring repositioning. The efficiency of the 3D printed extracorporeal positioning guide technique was 76.92%, a CT examination was performed one month after surgery, and three patients had residual lesions. CONCLUSIONS 3D-printed extracorporeal positioning guides can assist ultrasound in localizing tumors during liver microwave ablation and reduce repeated punctures. It makes percutaneous microwave ablation of the liver more precise and safe. However, the current study sample is small, there are still apparent shortcomings, and long-term clinical studies are needed to prove its effectiveness.
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Affiliation(s)
- Yu Zhang
- Guizhou University Medical College, Guiyang, Guizhou Province, China
| | - Ming-Yue Wang
- Guizhou Medoll Company, Oriental Pearl Tower, Guizhou Province, China
| | - Li-Kui Wang
- Guizhou Medoll Company, Oriental Pearl Tower, Guizhou Province, China
| | - Sha Zhang
- Guizhou Medoll Company, Oriental Pearl Tower, Guizhou Province, China
| | - Hong Sun
- Guizhou Medoll Company, Oriental Pearl Tower, Guizhou Province, China
| | - Jun Liu
- Guizhou University Medical College, Guiyang, Guizhou Province, China
- Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China
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13
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Chen X, Yan Y, Li A, Wang T, Wang Y. Robot-Assisted Needle Insertion for CT-Guided Puncture: Experimental Study with a Phantom and Animals. Cardiovasc Intervent Radiol 2023; 46:128-135. [PMID: 36380153 DOI: 10.1007/s00270-022-03301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate the accuracy and safety of robotic CT-guided needle insertion in phantom and animal experiments. MATERIALS AND METHODS A robotic system was developed for CT-guided needle insertion. For the phantom experiment, a specially made phantom containing multiple spherical was used. 15 robotic and manual insertions were conducted, and the accuracy, time, number of needle insertions, and radiation dose were compared between the robotic and manual insertion using Student's t-test. For the animal experiment, 20 robotic needle insertions were attempted toward simulated pulmonary nodules in the swine lung. The accuracy and safety of robotic CT-guided needle insertions were evaluated. RESULTS In the phantom experiment, the mean accuracies of manual and robotic insertion were 1.8 ± 0.3 mm and 1.9 ± 0.2 mm. The accuracy of robotic needle insertion had no significant difference with manual needle insertion, but the number of needle insertions and radiation dose of the robotic needle placement significantly decreased compared to manual needle placement. In the animal experiment, the mean accuracy of the robotic needle insertion was 3.8 ± 1.3 mm. The time for the whole needle insertion was 14.4 ± 4.8 min. The whole robotic needle insertions were safe and only one mild pneumothorax occurred. CONCLUSION CT-guided robotic needle insertion showed accuracy comparable to manual needle insertion, but the number of needle insertions, confirmatory scans, and radiation exposure had been reduced significantly. In future, we will further apply the robotic system to clinical experiments.
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Affiliation(s)
- Xiangqian Chen
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yadong Yan
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ailing Li
- Beijing TrueHealth Medical Technology Co., Ltd., Beijing, China
| | - Tianmiao Wang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
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14
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Lanza C, Carriero S, Buijs EFM, Mortellaro S, Pizzi C, Sciacqua LV, Biondetti P, Angileri SA, Ianniello AA, Ierardi AM, Carrafiello G. Robotics in Interventional Radiology: Review of Current and Future Applications. Technol Cancer Res Treat 2023; 22:15330338231152084. [PMID: 37113061 PMCID: PMC10150437 DOI: 10.1177/15330338231152084] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
This review is a brief overview of the current status and the potential role of robotics in interventional radiology. Literature published in the last decades, with an emphasis on the last 5 years, was reviewed and the technical developments in robotics and navigational systems using CT-, MR- and US-image guidance were analyzed. Potential benefits and disadvantages of their current and future use were evaluated. The role of fusion imaging modalities and artificial intelligence was analyzed in both percutaneous and endovascular procedures. A few hundred articles describing results of single or several systems were included in our analysis.
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Affiliation(s)
- Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | | | - Sveva Mortellaro
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Pizzi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | | | - Pierpaolo Biondetti
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | - Gianpaolo Carrafiello
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
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15
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Stereotactic Microwave Ablation of Hepatocellular Carcinoma: The Impact of Tumor Size and Minimal Ablative Margin on Therapeutic Success. Tomography 2022; 9:50-59. [PMID: 36648992 PMCID: PMC9844395 DOI: 10.3390/tomography9010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Microwave ablation (MWA) has gained relevance in the treatment of hepatic malignancies and especially in hepatocellular carcinoma (HCC), and it is an important alternative to surgery. The purpose of the study was to evaluate whether the minimal ablative margin (MAM) or the initial tumor size has a greater effect on the success of stereotactic MWA of HCC regarding the time to local tumor progression (LTP) and overall survival (OS). METHODS 88 patients, who received stereotactic MWA of 127 tumor lesions with a curative intention were included in this single-center, retrospective study. The MAM was evaluated in a side-by-side comparison of pre- and post-ablative, contrast-enhanced slice imaging. A Cox proportional hazard model with a frailty term was computed to assess the influence of the MAM and the maximum tumor diameter on the time to LTP and the OS. RESULTS The maximum tumor diameter was identified as a significant positive predictor for LTP (hazard ratio 1.04, 95% CI 1.00-1.08, p = 0.03), but it was not a significant positive predictor for the OS (p = 0.20). The MAM did not have a significant influence on LTP-free survival (p = 0.23) and OS (p = 0.67). CONCLUSION For the successful stereotactic MWA of HCC, the MAM and maximum tumor diameter might not have an influence on the OS, but the maximum tumor diameter seems to be an independent predictor of the time to LTP.
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16
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de Baère T, Roux C, Deschamps F, Tselikas L, Guiu B. Evaluation of a New CT-Guided Robotic System for Percutaneous Needle Insertion for Thermal Ablation of Liver Tumors: A Prospective Pilot Study. Cardiovasc Intervent Radiol 2022; 45:1701-1709. [PMID: 36127519 DOI: 10.1007/s00270-022-03267-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the feasibility and safety of a robotic system for percutaneous needle insertion during thermal ablation of liver tumors. MATERIALS AND METHODS This study analyzed the CT-guided percutaneous needle insertion using the EPIONE robotic device (Quantum Surgical, Montpellier, France) for radiofrequency or microwave liver ablation. The main criteria of the study were feasibility (possibility to perform the thermal ablation after needle insertion), the number of needle adjustments (reiteration of robotically assisted needle insertion when initial needle positioning is considered insufficient to perform ablation), and robotic-guided procedure safety (complications related to the needle insertion). Patients were followed up at 6 months post-intervention to assess local tumor control. RESULTS Twenty-one patients with 24 tumors, including 6 HCC and 18 metastases measuring 15.6 ± 7.2 mm, were enrolled. One patient (with one tumor) was excluded for protocol deviation. Robotic assisted thermal ablation was feasible for 22/23 lesions (95.7%) and 19/20 patients (95.0%), as validated by a data safety monitoring Board (95% CI [76.39%; 99.11%]) for the per-protocol population. The mean number of needle adjustments per tumor treated was 0.4 (SD: 0.7), with 70.8% of tumors requiring no adjustment. No adverse events were depicted. Rate of local tumor control was 83.3% for patients and 85.7% for tumors, at 6 months. CONCLUSION This bicentric first-in-human pilot study suggests both feasibility and safety of a stereotactic CT-guided EPIONE device for the percutaneous needle insertion during liver tumor thermal ablation.
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Affiliation(s)
- Thierry de Baère
- BIOTHERIS, Department of Interventional Radiology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| | - Charles Roux
- BIOTHERIS, Department of Interventional Radiology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Frédéric Deschamps
- BIOTHERIS, Department of Interventional Radiology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Lambros Tselikas
- BIOTHERIS, Department of Interventional Radiology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
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17
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Johnston EW, Basso J, Winfield J, McCall J, Khan N, Messiou C, Koh DM, Fotiadis N. Starting CT-guided robotic interventional oncology at a UK centre. Br J Radiol 2022; 95:20220217. [PMID: 35290098 PMCID: PMC10996412 DOI: 10.1259/bjr.20220217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE 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 (median 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). CONCLUSION 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.
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18
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Luerken L, Haimerl M, Doppler M, Uller W, Beyer LP, Stroszczynski C, Einspieler I. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. ROFO-FORTSCHR RONTG 2022; 194:1075-1086. [PMID: 35545102 DOI: 10.1055/a-1768-0954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Because many hepatocellular carcinomas are already unresectable at the time of initial diagnosis, percutaneous tumor ablation has become established in recent decades as a curative therapeutic approach for very early (BCLC 0) and early (BCLC A) HCC. The aim of this paper is to provide a concise overview of the percutaneous local ablative procedures currently in use, based on their technical characteristics as well as clinical relevance, taking into account the current body of studies. MATERIALS AND METHODS The literature search included all original papers, reviews, and meta-analyses available via MEDLINE and Pubmed on the respective percutaneous ablation procedures; the primary focus was on randomized controlled trials and publications from the last 10 years. RESULTS AND CONCLUSIONS Radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established procedures that are considered equal to surgical resection in the treatment of stage BCLC 0 and A HCC with a diameter up to 3 cm due to their strong evidence in international and national guidelines. For tumors with a diameter between 3 and 5 cm, the current S3 guidelines recommend a combination of transarterial chemoembolization (TACE) and thermal ablation using RFA or MWA as combination therapy is superior to thermal ablation alone in tumors of this size and shows comparable results to surgical resection in terms of overall survival. Alternative, less frequently employed thermal procedures include cryotherapy (CT) and laser ablation (LA). Non-thermal procedures include irreversible electroporation (IRE), interstitial brachytherapy (IBT), and most recently, electrochemotherapy (ECT). Due to insufficient evidence, these have only been used in individual cases and within the framework of studies. However, the nonthermal methods are a reasonable alternative for ablation of tumors adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods. With advances in the technology of the respective procedures, increasingly good evidence, and advancements in supportive techniques such as navigation devices and fusion imaging, percutaneous ablation procedures may expand their indications for the treatment of larger and more advanced tumors in the coming years. KEY POINTS · RFA and MWA are considered equal to surgical resection as a first-line therapy for the curative treatment of stage BCLC 0 and A HCCs with a diameter of up to 3 cm.. · For HCCs with a diameter between 3 and 5 cm, a combination of TACE and RFA or MWA is recommended. This combination therapy yields results comparable to those of surgical resection in terms of overall survival.. · Due to insufficient evidence, alternative ablation methods have only been used in individual cases and within the framework of studies. However, nonthermal methods, such as IRE, IBT, and, most recently, ECT, are a reasonable alternative for ablation of HCCs adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods.. CITATION FORMAT · Luerken L, Haimerl M, Doppler M et al. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1768-0954.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Hospital Regensburg, Germany
| | - Michael Haimerl
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany
| | - Michael Doppler
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Lukas Philipp Beyer
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany.,Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Germany
| | | | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Germany
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19
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Tinguely P, Paolucci I, Ruiter SJS, Weber S, de Jong KP, Candinas D, Freedman J, Engstrand J. Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:713685. [PMID: 34631539 PMCID: PMC8495244 DOI: 10.3389/fonc.2021.713685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/06/2021] [Indexed: 01/17/2023] Open
Abstract
Background Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors. Methods A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase, and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency, and treatment efficacy outcomes. Meta-analysis including subgroup analyses was performed. Results Thirty-four studies (two randomized controlled trials, three prospective cohort studies, 29 case series) were qualitatively analyzed, and 22 studies were included for meta-analysis. Weighted average lateral targeting error was 3.7 mm (CI 3.2, 4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications, and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1), and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1–6 weeks and 90% (87, 93) if assessed at 6–12 weeks post ablation, with remaining between-study heterogeneity. Primary technique efficacy was significantly enhanced in stereotactic vs. free-hand targeting, with odds ratio (OR) of 1.9 (1.2, 3.2) (n = 6 studies). Conclusions Advances in stereotactic navigation technologies allow highly precise and safe tumor targeting, leading to enhanced primary treatment efficacy. The use of varying definitions and terminology of safety and efficacy limits comparability among studies, highlighting the crucial need for further standardization of follow-up definitions.
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Affiliation(s)
- Pascale Tinguely
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.,Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Iwan Paolucci
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Simeon J S Ruiter
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
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20
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Lang Q, Zhong C, Liang Z, Zhang Y, Wu B, Xu F, Cong L, Wu S, Tian Y. Six application scenarios of artificial intelligence in the precise diagnosis and treatment of liver cancer. Artif Intell Rev 2021. [DOI: 10.1007/s10462-021-10023-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Luerken L, Doppler M, Brunner SM, Schlitt HJ, Uller W. Stereotactic Percutaneous Electrochemotherapy as Primary Approach for Unresectable Large HCC at the Hepatic Hilum. Cardiovasc Intervent Radiol 2021; 44:1462-1466. [PMID: 34036404 PMCID: PMC8382613 DOI: 10.1007/s00270-021-02841-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/05/2021] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy (ECT) is a novel non-thermal ablative technique that combines chemotherapy and the application of electric pulses for reversible cell membrane electroporation. This method was recently performed in the treatment of deep-seated liver tumors during open surgery but experience about percutaneous ECT is rare and further developments like combination of percutaneous ECT with stereotactic navigated devices may be very promising. We report on a case of a 4.7 × 4.5 × 3.5 cm unresectable HCC at the hepatic hilum adjacent to the major vessels and the bile duct that was successfully treated using percutaneous ECT in combination with stereotactic navigation. Follow-up imaging 6 weeks and 6 months after ECT showed complete response.
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Affiliation(s)
- L Luerken
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - M Doppler
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - S M Brunner
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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23
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Accuracy of Electrode Placement in IRE Treatment with Navigated Guidance. Cardiovasc Intervent Radiol 2021; 44:968-975. [PMID: 33474604 PMCID: PMC8172499 DOI: 10.1007/s00270-020-02762-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/24/2020] [Indexed: 01/03/2023]
Abstract
Purpose Evaluate the accuracy of multiple electrode placements in IRE treatment of liver tumours using a stereotactic CT-based navigation system. Method Analysing data from all IRE treatments of liver tumours at one institution until 31 December 2018. Comparing planned with validated electrode placement. Analysing lateral and angular errors and parallelism between electrode pairs Results Eighty-four tumours were treated in 60 patients. Forty-six per cent were hepatocellular carcinoma, and 36% were colorectal liver metastases. The tumours were located in all segments of the liver. Data were complete from 51 treatments. Two hundred and six electrodes and 336 electrode pairs were analysed. The median lateral and angular error, comparing planned and validated electrode placement, was 3.6 mm (range 0.2–13.6 mm) and 3.1° (range 0°–16.1°). All electrodes with a lateral error >10 mm were either re-positioned or excluded before treatment. The median angle between the electrode pairs was 3.8° (range 0.3°–17.2°). There were no electrode placement-related complications. Conclusion The use of a stereotactic CT-based system for navigation of electrode placement in IRE treatment of liver tumours is safe, accurate and user friendly.
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He XF, Xiao YY, Zhang X, Zhang XB, Zhang X, Wei YT, Zhang ZL, Wiggermann P. Preliminary clinical application of the robot-assisted CT-guided irreversible electroporation ablation for the treatment of pancreatic head carcinoma. Int J Med Robot 2020; 16:e2099. [PMID: 32112493 DOI: 10.1002/rcs.2099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/08/2020] [Accepted: 02/23/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To evaluate the feasibility and safety of a robot-guided irreversible electroporation (IRE) ablation system for the treatment of pancreatic head carcinoma. METHODS A total of 20 cases with pancreatic head carcinoma were divided into two groups: 11 cases in group A with manual probe placement and 9 cases in group B with robotic navigated probe placement. The two groups were compared in terms of planning time before puncture, puncture time, the total time of electrode deployment, number of scans, and punctual accuracy of the single electrode. RESULTS Each probe was successfully punctured, and no complications were detected. P-values were calculated for all the parameters, using the SPSS 25.0 software and the t test. CONCLUSIONS The new robot can reduce the total operating time as compared to the manual probe placement with the same accuracy in the IRE of pancreatic head carcinoma.
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Affiliation(s)
- Xiao F He
- Department of Diagnostic Radiology, Medical School of Chinese PLA, Beijing, China
| | - Yue Y Xiao
- Department of Diagnostic Radiology, Medical School of Chinese PLA, Beijing, China
| | - Xiao Zhang
- Department of Diagnostic Radiology, Medical School of Chinese PLA, Beijing, China
| | - Xiao B Zhang
- Department of Diagnostic Radiology, Medical School of Chinese PLA, Beijing, China
| | - Xin Zhang
- Department of Diagnostic Radiology, Medical School of Chinese PLA, Beijing, China
| | - Ying T Wei
- Department of Diagnostic Radiology, Medical School of Chinese PLA, Beijing, China
| | - Zhong L Zhang
- Department of Diagnostic Radiology, Medical School of Chinese PLA, Beijing, China
| | - Philipp Wiggermann
- Chefarzt des Instituts für Röntgendiagnostik u. Nuklearmedizin Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
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Improvement of the primary efficacy of microwave ablation of malignant liver tumors by using a robotic navigation system. Radiol Oncol 2020; 54:295-300. [PMID: 32463387 PMCID: PMC7409605 DOI: 10.2478/raon-2020-0033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background The aim of the study was to assess the primary efficacy of robot-assisted microwave ablation and compare it to manually guided microwave ablation for percutaneous ablation of liver malignancies. Patients and methods We performed a retrospective single center evaluation of microwave ablations of 368 liver tumors in 192 patients (36 female, 156 male, mean age 63 years). One hundred and nineteen ablations were performed between 08/2011 and 03/2014 with manual guidance, whereas 249 ablations were performed between 04/2014 and 11/2018 using robotic guidance. A 6-week follow-up (ultrasound, computed tomography and magnetic resonance imaging) was performed on all patients. Results The primary technique efficacy outcome of the group treated by robotic guidance was significantly higher than that of the manually guided group (88% vs. 76%; p = 0.013). Multiple logistic regression analysis indicated that a small tumor size (≤ 3 cm) and robotic guidance were significant favorable prognostic factors for complete ablation. Conclusions In addition to a small tumor size, robotic navigation was a major positive prognostic factor for primary technique efficacy.
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Citone M, Fanelli F, Falcone G, Mondaini F, Cozzi D, Miele V. A closer look to the new frontier of artificial intelligence in the percutaneous treatment of primary lesions of the liver. Med Oncol 2020; 37:55. [PMID: 32424627 DOI: 10.1007/s12032-020-01380-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
The purpose of thermal ablation is induction of tumor death by means of localized hyperthermia resulting in irreversible cellular damage. Ablative therapies are well-recognized treatment modalities for HCC lesions and are considered standard of care for HCC nodules < 3 cm in diameter in patients not suitable for surgery. Effective lesion treatment rely on complete target volume ablation. Technical limitations are represented by large (> 3 cm) or multicentric nodules as well as complex nodule location and poor lesion conspicuity. Artificial Intelligence (AI) is a general term referred to computational algorithms that can analyze data and perform complex tasks otherwise prerogative of Human Intelligence. AI has a variety of application in percutaneous ablation procedures such as Navigational software, Fusion Imaging, and robot-assisted ablation tools. Those instruments represent relative innovations in the field of Interventional Oncology and promising strategies to overcome actual limitations of ablative therapy in order to increase feasibility and technical results. This work aims to review the principal application of Artificial Intelligence in the percutaneous ablation of primary lesions of the liver with special focus on how AI can impact in the treatment of HCC especially on potential advantages on the drawbacks of the conventional technique.
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Affiliation(s)
- M Citone
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - F Fanelli
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - G Falcone
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - F Mondaini
- Vascular and Interventional Radiology Department, Careggi University Hospital, Florence, Italy
| | - D Cozzi
- Emergency Radiology Department, Careggi University Hospital, L.go G.A. Brambilla, 3, 50134, Florence, Italy
| | - V Miele
- Emergency Radiology Department, Careggi University Hospital, L.go G.A. Brambilla, 3, 50134, Florence, Italy.
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Volpi S, Tsoumakidou G, Loriaud A, Hocquelet A, Duran R, Denys A. Electromagnetic navigation system combined with High-Frequency-Jet-Ventilation for CT-guided hepatic ablation of small US-Undetectable and difficult to access lesions. Int J Hyperthermia 2019; 36:1051-1057. [DOI: 10.1080/02656736.2019.1671612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Stephanie Volpi
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
- Department of Radiology, Institut de Cancerologie de l’Ouest-René Gauducheau, Saint Herblain Cedex, France
| | - Georgia Tsoumakidou
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Amélie Loriaud
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
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Lachenmayer A, Tinguely P, Maurer MH, Frehner L, Knöpfli M, Peterhans M, Weber S, Dufour JF, Candinas D, Banz V. Stereotactic image-guided microwave ablation of hepatocellular carcinoma using a computer-assisted navigation system. Liver Int 2019; 39:1975-1985. [PMID: 31276296 DOI: 10.1111/liv.14187] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. METHODS Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. RESULTS In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). CONCLUSION Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations.
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Affiliation(s)
- Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascale Tinguely
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Frehner
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marina Knöpfli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jean-François Dufour
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Fuhrmann I, Probst U, Wiggermann P, Beyer L. Navigation Systems for Treatment Planning and Execution of Percutaneous Irreversible Electroporation. Technol Cancer Res Treat 2018; 17:1533033818791792. [PMID: 30071779 PMCID: PMC6077881 DOI: 10.1177/1533033818791792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The application of navigational systems has the potential to improve percutaneous interventions. The accuracy of ablation probe placement can be increased and radiation doses reduced. Two different types of systems can be distinguished, tracking systems and robotic systems. This review gives an overview of navigation devices for clinical application and summarizes first findings in the implementation of navigation in percutaneous interventions using irreversible electroporation. Because of the high number of navigation systems, this review focuses on commercially available ones.
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Affiliation(s)
- Irene Fuhrmann
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Ute Probst
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Philipp Wiggermann
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Beyer
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Hiraki T, Matsuno T, Kamegawa T, Komaki T, Sakurai J, Matsuura R, Yamaguchi T, Sasaki T, Iguchi T, Matsui Y, Gobara H, Kanazawa S. Robotic Insertion of Various Ablation Needles Under Computed Tomography Guidance: Accuracy in Animal Experiments. Eur J Radiol 2018; 105:162-167. [PMID: 30017274 DOI: 10.1016/j.ejrad.2018.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the accuracy of robotic insertion of various ablation needles at various locations under computed tomography (CT) guidance in swine. MATERIALS AND METHODS The robot was used for CT-guided insertion of four ablation needles, namely a single internally cooled radiofrequency ablation (RFA) needle (Cool-tip), a multi-tined expandable RFA needle (LeVeen), a cryoablation needle (IceRod), and an internally cooled microwave ablation needle (Emprint). One author remotely operated the robot with the operation interface in order to orient and insert the needles under CT guidance. Five insertions of each type of ablation needle towards 1.0-mm targets in the liver, kidney, lung, and hip muscle were attempted on the plane of an axial CT image in six swine. Accuracy of needle insertion was evaluated as the three-dimensional length between the target centre and needle tip. The accuracy of needle insertion was compared according to the type of needle used and the location using one-way analysis of variance. RESULTS The overall mean accuracy of all four needles in all four locations was 2.8 mm. The mean accuracy of insertion of the Cool-tip needle, LeVeen needle, IceRod needle, and Emprint needle was 2.8 mm, 3.1 mm, 2.5 mm, and 2.7 mm, respectively. The mean accuracy of insertion into the liver, kidney, lung, and hip muscle was 2.7 mm, 2.9 mm, 2.9 mm, and 2.5 mm, respectively. There was no significant difference in insertion accuracy among the needles (P = .38) or the locations (P = .53). CONCLUSION Robotic insertion of various ablation needles under CT guidance was accurate regardless of type of needle or location in swine.
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Affiliation(s)
- Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Takayuki Matsuno
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsusimanaka, Kitaku, Okayama 700-8530, Japan
| | - Tetsushi Kamegawa
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsusimanaka, Kitaku, Okayama 700-8530, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Ryutaro Matsuura
- Graduate School of Health Sciences, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takuya Yamaguchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takanori Sasaki
- Collaborative Research Center for OMIC, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Beyer LP, Lürken L, Verloh N, Haimerl M, Michalik K, Schaible J, Stroszczynski C, Wiggermann P. Stereotactically navigated percutaneous microwave ablation (MWA) compared to conventional MWA: a matched pair analysis. Int J Comput Assist Radiol Surg 2018; 13:1991-1997. [PMID: 29728899 DOI: 10.1007/s11548-018-1778-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/26/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare CT-navigated stereotactic microwave ablation (SMWA) to non-navigated conventional MWA (CMWA) for percutaneous ablation of liver malignancies. METHODS A matched pair analysis of 36 patients who underwent MWA of primary or secondary liver malignancies (10 hepatocellular carcinoma and 8 metastases) was conducted. A total of 18 patients undergoing SMWA were included in this prospective study. Patients were matched in terms of tumor size, liver segment and entity to retrospective CMWA procedures. The endpoints were procedure time, accuracy of needle placement, technical success rate, complication rate and dose-length product (DLP). RESULTS The procedure durations were 23.9 min (SD 3.7) for CMWA and 21.8 min (SD 16.3) for SMWA (p = 0.22). The procedural accuracy for SMWA and CMWA was identical for both groups (3.7 mm). The total DLP was significantly lower for SMWA than for CMWA (2115 mGy cm (SD 276) vs. 3109 mGy cm (SD 1137), respectively; p < 0.01). Complete ablation without residual tumor was observed in 94% (17 of 18) of SMWA and in 83% (15 of 18) of CMWA patients (p = 0.31). No complications occurred. CONCLUSIONS SMWA is highly accurate and reduces the radiation dose without increasing the procedure time.
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Affiliation(s)
- L P Beyer
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany.
| | - L Lürken
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - N Verloh
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - M Haimerl
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - K Michalik
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - J Schaible
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - P Wiggermann
- Department of Radiology, University Hospital Regensburg, 93053, Regensburg, Germany
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Li D, Cheng Z, Chen G, Liu F, Wu W, Yu J, Gu Y, Liu F, Ren C, Liang P. A multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors: a preclinical study. Int J Hyperthermia 2018; 34:1194-1201. [PMID: 29566561 DOI: 10.1080/02656736.2018.1456680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Dongrui Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Gang Chen
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Wenbo Wu
- Beijing Baihui Weikang Medical Robot Technology Co., Ltd, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ying Gu
- Department of Laser Medicine, Chinese PLA General Hospital, Beijing, China
| | - Fengyong Liu
- Department of Intervention Therapy, Chinese PLA General Hospital, Beijing, China
| | - Chao Ren
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Li R, Xu S, Pritchard WF, Karanian JW, Krishnasamy VP, Wood BJ, Tse ZTH. AngleNav: MEMS Tracker to Facilitate CT-Guided Puncture. Ann Biomed Eng 2018; 46:452-463. [PMID: 29305735 DOI: 10.1007/s10439-017-1968-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022]
Abstract
As a low-cost needle navigation system, AngleNav may be used to improve the accuracy, speed, and ease of CT-guided needle punctures. The AngleNav hardware includes a wireless device with a microelectromechanical (MEMS) tracker that can be attached to any standard needle. The physician defines the target, desired needle path and skin entry point on a CT slice image. The accuracy of AngleNav was first tested in a 3D-printed calibration platform in a benchtop setting. An abdominal phantom study was then performed in a CT scanner to validate the accuracy of the device's angular measurement. Finally, an in vivo swine study was performed to guide the needle towards liver targets (n = 8). CT scans of the targets were used to quantify the angular errors and needle tip-to-targeting distance errors between the planned needle path and the final needle position. The MEMS tracker showed a mean angular error of 0.01° with a standard deviation (SD) of 0.62° in the benchtop setting. The abdominal phantom test showed a mean angular error of 0.87° with an SD of 1.19° and a mean tip-to-target distance error of 4.89 mm with an SD of 1.57 mm. The animal experiment resulted in a mean angular error of 6.6° with an SD of 1.9° and a mean tip-to-target distance error of 8.7 mm with an SD of 3.1 mm. These results demonstrated the feasibility of AngleNav for CT-guided interventional workflow. The angular and distance errors were reduced by 64.4 and 54.8% respectively if using AngleNav instead of freehand insertion, with a limited number of operators. AngleNav assisted the physicians to deliver accurate needle insertion during CT-guided intervention. The device could potentially reduce the learning curve for physicians to perform CT-guided needle targeting.
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Affiliation(s)
- Rui Li
- School of Electrical and Computer Engineering, The University of Georgia, Athens, GA, 30602, USA
| | - Sheng Xu
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - William F Pritchard
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - John W Karanian
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - Zion Tsz Ho Tse
- School of Electrical and Computer Engineering, The University of Georgia, Athens, GA, 30602, USA. .,3T Technologies, LLC, Marietta, GA, 30067, USA.
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Performance of a Robotic Assistance Device in Computed Tomography-Guided Percutaneous Diagnostic and Therapeutic Procedures. Cardiovasc Intervent Radiol 2017; 41:639-644. [PMID: 29159685 DOI: 10.1007/s00270-017-1841-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate a commercially available robotic assistance device for computed tomography-guided diagnostic and therapeutic interventions, compared to regular, manually performed CT scan-guided interventions in terms of precision, exposure to radiation to the patient and intervention time. MATERIALS AND METHODS Over a period of 6 months, 55 consecutive patients were recruited and treated using robotic assistance and compared to a control group of 101 patients previously treated with a regular CT scan-guided, manual approach. Evaluated parameters were precision (deviation from planned target and number of needle replacements), radiation exposure to the patient and intervention time. Evaluations were performed with regard to complexity (in-plane vs out-of-plane interventions) and type of anesthesia (general vs local). RESULTS Parameters related to precision were in general significantly better in the robotic assistance group (p < 0.01) with a mean deviation of 1.2 mm (± 1.6 mm) compared to 2.6 mm (± 1.1 mm) in the comparison group. Compared to manual procedure, the mean intervention time was reduced by 15 min (± 5.4 min) on average for an out-of-plane needle placement in the robotic group. There was no increase of exposure to radiation to the patient while radiation exposure for the physician was reduced to zero when the navigation system was used. CONCLUSION Compared to manual placement, the use of a robotic assistance device in out-of-plane CT-guided interventions under general anesthesia allows for probe placement with high precision. Intervention time is reduced with no increase of exposure to radiation to the patient.
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Beyer LP, Wiggermann P. Planning and guidance: New tools to enhance the human skills in interventional oncology. Diagn Interv Imaging 2017; 98:583-588. [PMID: 28818346 DOI: 10.1016/j.diii.2017.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
Abstract
Navigation systems have the potential to achieve a high accuracy for percutaneous ablation of tumors even for those in difficult locations. In the last years, successful research has been conducted to make navigation devices applicable to percutaneous tumor ablation with special planning software that now allows high accuracy even for deep-located small lesions close to critical structures. Because of the high number of available navigation systems, this review focuses on those with preexisting clinical studies.
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Affiliation(s)
- L P Beyer
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
| | - P Wiggermann
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Yang T, Case JB, Boston S, Dark MJ, Toskich B. Microwave ablation for treatment of hepatic neoplasia in five dogs. J Am Vet Med Assoc 2017; 250:79-85. [PMID: 28001112 DOI: 10.2460/javma.250.1.79] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 5 dogs between 9 and 11 years of age were evaluated for treatment of primary (n = 2) or metastatic (3) hepatic neoplasia. CLINICAL FINDINGS Patients were evaluated on an elective (n = 3) or emergency (2) basis. Two dogs with primary hepatic neoplasia were evaluated because of lethargy and inappetence. One dog was referred after an enlarged anal sac was detected via palpation per rectum during a routine physical examination. Two dogs were evaluated on an emergency basis because of lethargy and weakness, and hemoabdomen in the absence of a history of trauma was detected. All 5 dogs underwent thoracic radiography and abdominal ultrasonography, with CT performed in both dogs with primary hepatic neoplasia. All dogs had preoperative evidence of abdominal neoplasia, and none had evidence of thoracic metastasis. TREATMENT AND OUTCOME All dogs underwent ventral midline laparotomy and had diffuse hepatic neoplasia that precluded complete resection. Locoregional treatment with MWA was applied to hepatic lesions (0.5 to 2.5 cm diameter) without procedural complications. Histopathologic diagnoses were biliary adenocarcinoma (n = 1), hemangiosarcoma (2), hepatocellular carcinoma (1), and apocrine gland adenocarcinoma (1). CLINICAL RELEVANCE MWA is being increasingly used as an adjunct in the surgical treatment of human patients with primary and metastatic liver disease. Results of the present small case series suggested that MWA is feasible and potentially effective as an adjunctive treatment for appropriately selected dogs with nonresectable hepatic tumors. Further investigation is indicated.
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Stereotactic CT-Guided Percutaneous Microwave Ablation of Liver Tumors With the Use of High-Frequency Jet Ventilation: An Accuracy and Procedural Safety Study. AJR Am J Roentgenol 2016; 208:193-200. [PMID: 27762601 DOI: 10.2214/ajr.15.15803] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of the present study is to evaluate the accuracy and safety of antenna placement performed with the use of a CT-guided stereotactic navigation system for percutaneous ablation of liver tumors and to assess the safety of high-frequency jet ventilation for target motion control. MATERIALS AND METHODS Twenty consecutive patients with malignant liver lesions for which surgical resection was contraindicated or that were not readily visible on ultrasound or not accessible by ultrasound guidance were included in the study. Patients were treated with percutaneous microwave ablation performed using a CT-guided stereotactic navigation system. High-frequency jet ventilation was used to reduce liver motion during all interventions. The accuracy of antenna placement, the number of needle readjustments required, overall safety, and the radiation doses were assessed. RESULTS Microwave ablation was completed for 20 patients (28 lesions). Performance data could be evaluated for 17 patients with 25 lesions (mean [± SD] lesion diameter, 14.9 ± 5.9 mm; mean lesion location depth, 87.5 ± 27.3 mm). The antennae were placed with a mean lateral error of 4.0 ± 2.5 mm, a depth error of 3.4 ± 3.2 mm, and a total error of 5.8 ± 3.2 mm in relation to the intended target. The median number of antenna readjustments required was zero (range, 0-1 adjustment). No major complications were related to either the procedure or the use of high-frequency jet ventilation. The mean total patient radiation dose was 957.5 ± 556.5 mGy × cm, but medical personnel were not exposed to irradiation. CONCLUSION Percutaneous microwave ablation performed with CT-guided stereotactic navigation provides sufficient accuracy and requires almost no repositioning of the needle. Therefore, it is technically feasible and applicable for safe treatments.
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Beyer LP, Pregler B, Michalik K, Niessen C, Dollinger M, Müller M, Schlitt HJ, Stroszczynski C, Wiggermann P. Evaluation of a robotic system for irreversible electroporation (IRE) of malignant liver tumors: initial results. Int J Comput Assist Radiol Surg 2016; 12:803-809. [PMID: 27653615 DOI: 10.1007/s11548-016-1485-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/01/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Comparison of conventional CT-guided manual irreversible electroporation (IRE) of malignant liver tumors and a robot-assisted approach regarding procedural accuracy, intervention time, dose, complications, and treatment success. METHODS A retrospective single-center analysis of 40 cases of irreversible electroporation of malignant liver tumors in 35 patients (6 females, 29 males, average age 60.3 years). Nineteen of these ablation procedures were performed manually and 21 with robotic assistance. A follow-up (ultrasound, CT, and MRI) was performed after 6 weeks in all patients. RESULTS The time from the planning CT scan to the start of the ablation as well as the dose-length product were significantly lower under robotic assistance (63.5 vs. 87.4 min, [Formula: see text]; 2132 vs. 4714 mGy cm, [Formula: see text]). The procedural accuracy, measured as the deviation of the IRE probes with respect to a defined reference probe, was significantly higher using robotic guidance (2.2 vs. 3.1 mm, [Formula: see text]). There were no complications. There was one incomplete ablation in the manual group. CONCLUSION Robotic assistance for IRE of liver tumors allows for faster procedure times with higher accuracy while reducing radiation dose as compared to the manual placement of IRE probes.
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Affiliation(s)
- L P Beyer
- Department of Radiology, University Medical Center Regensburg, 93053, Regensburg, Germany.
| | - B Pregler
- Department of Radiology, University Medical Center Regensburg, 93053, Regensburg, Germany
| | - K Michalik
- Department of Radiology, University Medical Center Regensburg, 93053, Regensburg, Germany
| | - C Niessen
- Department of Radiology, University Medical Center Regensburg, 93053, Regensburg, Germany
| | - M Dollinger
- Department of Radiology, University Medical Center Regensburg, 93053, Regensburg, Germany
| | - M Müller
- Department of Internal Medicine I, University Medical Center Regensburg, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, 93053, Regensburg, Germany
| | - P Wiggermann
- Department of Radiology, University Medical Center Regensburg, 93053, Regensburg, Germany
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Beyer LP, Michalik K, Niessen C, Platz Batista da Silva N, Wiesinger I, Stroszczynski C, Wiggermann P. Evaluation of a Robotic Assistance-System For Percutaneous Computed Tomography-Guided (CT-Guided) Facet Joint Injection: A Phantom Study. Med Sci Monit 2016; 22:3334-9. [PMID: 27648509 PMCID: PMC5042119 DOI: 10.12659/msm.900686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to compare robotic assisted and freehand facet joint puncture on a phantom model in regards to time requirements and puncture accuracy. Material/Methods Forty facet joints were punctured, 20 using a robotic guidance system and 20 using a freehand procedure. Side and height of the facet joints were randomized and identical for both groups. Procedural accuracy, defined as axial and sagittal deviation, as well as the number of corrections were assessed. Procedure times for each step were documented and time requirements for pre-positioning, reconstruction, planning, and total intervention were calculated. Results Total procedure time for robotic guidance was 259±111 seconds versus 119±77 seconds for freehand procedure (p=1.0). Procedural accuracy for robotic guidance was significantly higher with 0 corrections versus 1.3 corrections for freehand procedure (p=0.02). Needle deviation in the robotics arm was 0.35±1.1 mm in the axial and 2.15±1.2 mm in the sagittal reconstruction. Conclusions Robotic assisted puncture of the facet joint allowed accurate positioning of the needle with a lower number of needle readjustments. Higher procedural accuracy was marginally offset by a slightly longer intervention time.
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Affiliation(s)
- Lukas Philipp Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Katharina Michalik
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Niessen
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Isabell Wiesinger
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Beyer LP, Pregler B, Nießen C, Schicho A, Haimerl M, Jung EM, Stroszczynski C, Wiggermann P. Stereotactically-navigated percutaneous Irreversible Electroporation (IRE) compared to conventional IRE: a prospective trial. PeerJ 2016; 4:e2277. [PMID: 27602266 PMCID: PMC4991851 DOI: 10.7717/peerj.2277] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
Purpose. The purpose of this study was to compare CT-navigated stereotactic IRE (SIRE) needle placement to non-navigated conventional IRE (CIRE) for percutaneous ablation of liver malignancies. Materials and Methods. A prospective trial including a total of 20 patients was conducted with 10 patients in each arm of the study. IRE procedures were guided using either CT fluoroscopy (CIRE) or a stereotactic planning and navigation system (SIRE). Primary endpoint was procedure time. Secondary endpoints were accuracy of needle placement, technical success rate, complication rate and dose-length product (DLP). Results. A total of 20 IRE procedures were performed to ablate hepatic malignancies (16 HCC, 4 liver metastases), 10 procedures in each arm. Mean time for placement of IRE electrodes in SIRE was significantly shorter with 27 ± 8 min compared to 87 ± 30 min for CIRE (p < 0.001). Accuracy of needle placement for SIRE was higher than CIRE (2.2 mm vs. 3.3 mm mean deviation, p < 0.001). The total DLP and the fluoroscopy DLP were significantly lower in SIRE compared to CIRE. Technical success rate and complication rates were equal in both arms. Conclusion. SIRE demonstrated a significant reduction of procedure length and higher accuracy compared to CIRE. Stereotactic navigation has the potential to reduce radiation dose for the patient and the radiologist without increasing the risk of complications or impaired technical success compared to CIRE.
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Affiliation(s)
- Lukas P Beyer
- Department of Radiology, University Hospital Regensburg , Regensburg , Germany
| | - Benedikt Pregler
- Department of Radiology, University Hospital Regensburg , Regensburg , Germany
| | - Christoph Nießen
- Department of Radiology, University Hospital Regensburg , Regensburg , Germany
| | - Andreas Schicho
- Department of Radiology, University Hospital Regensburg , Regensburg , Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg , Regensburg , Germany
| | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg , Regensburg , Germany
| | | | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg , Regensburg , Germany
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Freedman J, Harbut P. Navigated Percutaneous Lung Ablation under High-Frequency Jet Ventilation of a Metastasis from a Wilms' Tumour: A Paediatric Case Report. Case Rep Oncol 2016; 9:400-404. [PMID: 27721758 PMCID: PMC5043196 DOI: 10.1159/000447772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/25/2022] Open
Abstract
This is a case report of microwave energy being used to ablate an inoperable metastasis of a Wilms’ tumour in a 6-year-old boy using state-of-the-art navigated computed tomography targeting and high-frequency jet ventilation to reduce organ displacement and the potential risk of procedure-related pneumothorax. After the ablation, the young boy had high-dose chemotherapy followed by an autologous stem cell transplantation with rapid reduction of three recurrent right-sided lung metastases.
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Affiliation(s)
- Jacob Freedman
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
| | - Piotr Harbut
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
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Beyer LP, Pregler B, Niessen C, Dollinger M, Graf BM, Müller M, Schlitt HJ, Stroszczynski C, Wiggermann P. Robot-assisted microwave thermoablation of liver tumors: a single-center experience. Int J Comput Assist Radiol Surg 2015; 11:253-9. [PMID: 26307269 DOI: 10.1007/s11548-015-1286-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/17/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate and compare the needle placement accuracy, patient dose, procedural time, complication rate and ablation success of microwave thermoablation using a novel robotic guidance approach and a manual approach. METHODS We performed a retrospective single-center evaluation of 64 microwave thermoablations of liver tumors in 46 patients (10 female, 36 male, mean age 66 years) between June 2014 and February 2015. Thirty ablations were carried out with manual guidance, while 34 ablations were performed using robotic guidance. A 6-week follow-up (ultrasound, computed tomography and MRI) was performed on all patients. RESULTS The total procedure time and dose-length product were significantly reduced under robotic guidance (18.3 vs. 21.7 min, [Formula: see text]; 2216 vs. 2881 mGy[Formula: see text]cm, [Formula: see text]). The position of the percutaneous needle was more accurate using robotic guidance (needle deviation 1.6 vs. 3.3 mm, [Formula: see text]). There was no significant difference between both groups regarding the complication rate and the ablation success. CONCLUSION Robotic assistance for liver tumor ablation reduces patient dose and allows for fast positioning of the microwave applicator with high accuracy. The complication rate and ablation success of percutaneous microwave thermoablation of malignant liver tumors using either CT fluoroscopy or robotic guidance for needle positioning showed no significant differences in the 6-week follow-up.
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Affiliation(s)
- L P Beyer
- Department of Radiology, University Medical Center Regensburg, Franz-Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - B Pregler
- Department of Radiology, University Medical Center Regensburg, Franz-Josef Strauss Allee 11, 93053, Regensburg, Germany
| | - C Niessen
- Department of Radiology, University Medical Center Regensburg, Franz-Josef Strauss Allee 11, 93053, Regensburg, Germany
| | - M Dollinger
- Department of Radiology, University Medical Center Regensburg, Franz-Josef Strauss Allee 11, 93053, Regensburg, Germany
| | - B M Graf
- Department of Anesthesia, University Medical Center Regensburg, Regensburg, Germany
| | - M Müller
- Department of Internal Medicine I, University Medical Center Regensburg, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Franz-Josef Strauss Allee 11, 93053, Regensburg, Germany
| | - P Wiggermann
- Department of Radiology, University Medical Center Regensburg, Franz-Josef Strauss Allee 11, 93053, Regensburg, Germany
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Use of warm Ringer’s lactate solution in the management of locally advanced giant cell tumor of bone. Int J Clin Oncol 2015; 21:177-85. [DOI: 10.1007/s10147-015-0856-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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