Review of Robotic Needle Guide Systems for Percutaneous Intervention

Robotic systems in interventional oncology: a narrative review of the current status

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.

A novel computational fracture toughness model for soft tissue in needle insertion

During the process of percutaneous puncture vascular intervention operation in endoscopic liver surgery, high precision needle manipulation requires the accurate needle tissue interaction model where the tissue fracture toughness is an important parameter to describe the tissue crack propagation, as well as to estimate tissue deformation and target displacement. However, the existing studies on fracture toughness estimation did not consider Young's modulus and the organ capsule structure. In this paper, a novel computational fracture toughness model is proposed considering insertion velocity, needle diameter and Young's modulus in insertion process, where the fracture toughness is determined by the tissue surface deformation, which was estimated through energy modeling using integrated shell element and three-dimensional solid element. The testbed is built to study the effect of different insertion velocities, needle diameters and Young's modulus on fracture toughness. The experiment result shows that the estimated result of computational fracture toughness model agrees well with the physical experimental data. In addition, the sensitivity analysis of different factors is conducted. Meanwhile, the model robustness analysis is investigated with different observation noises of Young's modulus and puncture displacement.

Towards a Procedure-Optimised Steerable Catheter for Deep-Seated Neurosurgery

In recent years, steerable needles have attracted significant interest in relation to minimally invasive surgery (MIS). Specifically, the flexible, programmable bevel-tip needle (PBN) concept was successfully demonstrated in vivo in an evaluation of the feasibility of convection-enhanced delivery (CED) for chemotherapeutics within the ovine model with a 2.5 mm PBN prototype. However, further size reductions are necessary for other diagnostic and therapeutic procedures and drug delivery operations involving deep-seated tissue structures. Since PBNs have a complex cross-section geometry, standard production methods, such as extrusion, fail, as the outer diameter is reduced further. This paper presents our first attempt to demonstrate a new manufacturing method for PBNs that employs thermal drawing technology. Experimental characterisation tests were performed for the 2.5 mm PBN and the new 1.3 mm thermally drawn (TD) PBN prototype described here. The results show that thermal drawing presents a significant advantage in miniaturising complex needle structures. However, the steering behaviour was affected due to the choice of material in this first attempt, a limitation which will be addressed in future work.

Image-guided prostate biopsy robots: A review

At present, the incidence of prostate cancer (PCa) in men is increasing year by year. So, the early diagnosis of PCa is of great significance. Transrectal ultrasonography (TRUS)-guided biopsy is a common method for diagnosing PCa. The biopsy process is performed manually by urologists but the diagnostic rate is only 20%-30% and its reliability and accuracy can no longer meet clinical needs. The image-guided prostate biopsy robot has the advantages of a high degree of automation, does not rely on the skills and experience of operators, reduces the work intensity and operation time of urologists and so on. Capable of delivering biopsy needles to pre-defined biopsy locations with minimal needle placement errors, it makes up for the shortcomings of traditional free-hand biopsy and improves the reliability and accuracy of biopsy. The integration of medical imaging technology and the robotic system is an important means for accurate tumor location, biopsy puncture path planning and visualization. This paper mainly reviews image-guided prostate biopsy robots. According to the existing literature, guidance modalities are divided into magnetic resonance imaging (MRI), ultrasound (US) and fusion image. First, the robot structure research by different guided methods is the main line and the actuators and material research of these guided modalities is the auxiliary line to introduce and compare. Second, the robot image-guided localization technology is discussed. Finally, the image-guided prostate biopsy robot is summarized and suggestions for future development are provided.

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

Background

We evaluated the accuracy, safety, and feasibility of a computed tomography (CT)-guided robotic assistance system for percutaneous needle placement in the kidney.

Methods

Fiducials surgically implanted into the kidneys of two pigs were used as targets for subsequent robotically-assisted needle insertion. Robotically-assisted needle insertions and CT acquisitions were coordinated using respiratory monitoring. An initial scan volume data set was used for needle insertion planning defining skin entry and target point. Then, needle insertion was performed according to robot positioning. The accuracy of needle placement was evaluated upon the distance between the needle tip and the predefined target on a post needle insertion scan. A delayed contrast-enhanced CT scan was acquired to assess safety.

Results

Eight needle trajectories were performed with a median procedural time measured from turning on the robotic system to post needle insertion CT scan of 21 min (interquartile range 15.5−26.5 min). Blind review of needle placement accuracy was 2.3 ± 1.2 mm (mean ± standard deviation) in lateral deviation, 0.7 ± 1.7 mm in depth deviation, and 2.8 ± 1.3 mm in three-dimensional Euclidian deviation. All needles were inserted on the first attempt, which determined 100% feasibility, without needle readjustment. The angulation and length of the trajectory did not impact on the needle placement accuracy. Two minor procedure-related complications were encountered: 2 subcapsular haematomas (13 × 6 mm and 35 × 6 mm) in the same animal.

Conclusions

Robotically-assisted needle insertion was shown feasible, safe and accurate in a swine kidney model. Further larger studies are needed.

A Brief Insight on Magnetic Resonance Conditional Neurosurgery Robots

The brain is a delicate organ in the human body that requires extreme care. Brain-related diseases are unavoidable. Perse, neurosurgery is a complicated procedure that demands high precision and accuracy. Developing a surgical robot is a complex task. To date, there are only a handful of neurosurgery robots in the market that distinctly undergo clinical procedures. These robots have exorbitant cost that hinders the utmost care progress in the area as they are unaffordable. This paper looked at the historical perspective and presented insight literature of the magnetic resonance conditional stereotactic neurosurgery robots that find their ways in clinics, abandoning research projects and promising research yet to undergo clinical use. In addition, the study also gives a thorough insight into the advantage of magnetic resonance imaging modalities and magnetic resonance conditional robots and the future challenges in automation use. Image compatibility test data and accuracy results are also examined because they guarantee that these systems work correctly in particular imaging settings. The primary differences between these systems include actuation and control technologies, construction materials, and the degree of freedom. Thus, one system has an advantage over the other.

AI-Enabled, Ultrasound-Guided Handheld Robotic Device for Femoral Vascular Access

Hemorrhage is a leading cause of trauma death, particularly in prehospital environments when evacuation is delayed. Obtaining central vascular access to a deep artery or vein is important for administration of emergency drugs and analgesics, and rapid replacement of blood volume, as well as invasive sensing and emerging life-saving interventions. However, central access is normally performed by highly experienced critical care physicians in a hospital setting. We developed a handheld AI-enabled interventional device, AI-GUIDE (Artificial Intelligence Guided Ultrasound Interventional Device), capable of directing users with no ultrasound or interventional expertise to catheterize a deep blood vessel, with an initial focus on the femoral vein. AI-GUIDE integrates with widely available commercial portable ultrasound systems and guides a user in ultrasound probe localization, venous puncture-point localization, and needle insertion. The system performs vascular puncture robotically and incorporates a preloaded guidewire to facilitate the Seldinger technique of catheter insertion. Results from tissue-mimicking phantom and porcine studies under normotensive and hypotensive conditions provide evidence of the technique's robustness, with key performance metrics in a live porcine model including: a mean time to acquire femoral vein insertion point of 53 ± 36 s (5 users with varying experience, in 20 trials), a total time to insert catheter of 80 ± 30 s (1 user, in 6 trials), and a mean number of 1.1 (normotensive, 39 trials) and 1.3 (hypotensive, 55 trials) needle insertion attempts (1 user). These performance metrics in a porcine model are consistent with those for experienced medical providers performing central vascular access on humans in a hospital.

Workflow-Based Design and Evaluation of a Device for CBCT-Guided Biopsy

Biopsies for personalized cancer care can be performed with cone beam computed tomography (CBCT) guidance, but manual needle manipulation remains an issue due to X-ray exposure to physicians. Modern CBCT scanners integrate today real-time imaging and software assistance for needle planning. In this paper, these available features are exploited to design a novel device offering an intermediate level of assistance between simple passive mechanical devices of limited efficiency, and advanced robotic devices requiring adapted procedure workflows. Our resulting system is built to limit its impact on the current manual practice. It is patient-mounted and provides remote control of needle orientation and insertion. A multilayer phantom is specifically developed to reproduce interactions between the needle and soft abdominal tissues. It is used to experimentally evaluate the device added value by comparing assisted versus manual needle insertions. The device is shown to help reducing X-ray exposure by a factor 4, without impacting the accuracy obtained manually.