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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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Pilz da Cunha G, van Delden OM, Kazemier G, Vahrmeijer AL, Bonjer HJ, Meijerink MR, Swijnenburg RJ. Hybrid operating room applications for precision hepatobiliary surgery: A narrative review. J Surg Oncol 2024; 129:1265-1273. [PMID: 38567691 DOI: 10.1002/jso.27634] [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: 01/31/2024] [Accepted: 03/17/2024] [Indexed: 06/04/2024]
Abstract
This review summarizes the key applications of a hybrid operating room (HOR) in hepatobiliary surgery and explores the advantages, limitations, and future directions of its utilization. A comprehensive literature search was conducted in PubMed to identify articles reporting on the utilization of HORs in liver surgery. So far, the HOR has been limitedly applied in hepatobiliary surgery. It can offer an optimal environment for combining radiological and surgical interventions and for performing image-guided surgical navigation.
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Affiliation(s)
- Gabriela Pilz da Cunha
- Department of Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology, Amsterdam UMC Location Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Geert Kazemier
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexander L Vahrmeijer
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Jaap Bonjer
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rutger-Jan Swijnenburg
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Yang Z, Zhang M, Yan L, Xiao J, Li Y, Li X, Luo Y. Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up. Endocrine 2024:10.1007/s12020-023-03660-9. [PMID: 38801598 DOI: 10.1007/s12020-023-03660-9] [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: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time. METHODS PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain. CONCLUSIONS Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.
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Affiliation(s)
- Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Berman ZT, White RR. Local ablation in pancreatic cancer: some answers and more questions. Lancet Gastroenterol Hepatol 2024; 9:398-400. [PMID: 38513682 DOI: 10.1016/s2468-1253(24)00046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Zachary T Berman
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Rebekah R White
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA.
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Yin Y, de Haas RJ, Alves N, Pennings JP, Ruiter SJS, Kwee TC, Yakar D. Machine learning-based radiomic analysis and growth visualization for ablation site recurrence diagnosis in follow-up CT. Abdom Radiol (NY) 2024; 49:1122-1131. [PMID: 38289352 PMCID: PMC10955006 DOI: 10.1007/s00261-023-04178-4] [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: 10/19/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Detecting ablation site recurrence (ASR) after thermal ablation remains a challenge for radiologists due to the similarity between tumor recurrence and post-ablative changes. Radiomic analysis and machine learning methods may show additional value in addressing this challenge. The present study primarily sought to determine the efficacy of radiomic analysis in detecting ASR on follow-up computed tomography (CT) scans. The second aim was to develop a visualization tool capable of emphasizing regions of ASR between follow-up scans in individual patients. MATERIALS AND METHODS Lasso regression and Extreme Gradient Boosting (XGBoost) classifiers were employed for modeling radiomic features extracted from regions of interest delineated by two radiologists. A leave-one-out test (LOOT) was utilized for performance evaluation. A visualization method, creating difference heatmaps (diff-maps) between two follow-up scans, was developed to emphasize regions of growth and thereby highlighting potential ASR. RESULTS A total of 55 patients, including 20 with and 35 without ASR, were included in the radiomic analysis. The best performing model was achieved by Lasso regression tested with the LOOT approach, reaching an area under the curve (AUC) of 0.97 and an accuracy of 92.73%. The XGBoost classifier demonstrated better performance when trained with all extracted radiomic features than without feature selection, achieving an AUC of 0.93 and an accuracy of 89.09%. The diff-maps correctly highlighted post-ablative liver tumor recurrence in all patients. CONCLUSIONS Machine learning-based radiomic analysis and growth visualization proved effective in detecting ablation site recurrence on follow-up CT scans.
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Affiliation(s)
- Yunchao Yin
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Natalia Alves
- Diagnostic Image Analysis Group, Department of Medical Imaging, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Jan Pieter Pennings
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Simeon J S Ruiter
- Department of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Derya Yakar
- Department of Radiology, Medical Imaging Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Paolucci I, Albuquerque Marques Silva J, Lin YM, Fellman BM, Jones KA, Tatsui CE, Weinberg JS, Ruiz J, Tan J, Brock KK, Bale R, Odisio BC. Study Protocol STEREOLAB: Stereotactic Liver Ablation Assisted with Intra-Arterial CT Hepatic Arteriography and Ablation Confirmation Software Assessment. Cardiovasc Intervent Radiol 2023; 46:1748-1754. [PMID: 37563313 DOI: 10.1007/s00270-023-03524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE This study aims to evaluate the technical efficacy and local tumor progression-free survival (LTPFS) of a standardized workflow for thermal ablation of colorectal liver metastases (CRLM) consisting of CT during hepatic arteriography (CTHA)-based imaging analysis, stereotactic thermal ablation, and computer-based software assessment of ablation margins. MATERIALS AND METHODS This investigator initiated, single-center, single-arm prospective trial will enroll up to 50 patients (≤ 5 CRLM, Measuring ≤ 5 cm). Procedures will be performed in an angio-CT suite under general anesthesia. The primary objective is to estimate LTPFS with a follow-up of up to 2 years and secondary objectives are analysis of the impact of minimal ablative margins on LTPFS, adverse events, contrast media utilization and radiation exposure, overall oncological outcomes, and anesthesia/procedural time. Adverse events (AE) will be recorded by CTCAE (Common Toxicity Criteria for Adverse Events), and Bayesian optimal phase-2 design will be applied for major intraprocedural AE stop boundaries. The institutional CRLM ablation registry will be used as benchmark for comparative analysis with the historical cohort. DISCUSSION The STEREOLAB trial will introduce a high-precision and standardized thermal ablation workflow for CRLM consisting of CT during hepatic arteriography imaging, stereotactic guidance, and ablation confirmation. Trial Registration ClinicalTrials.gov identifier: (NCT05361551).
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Affiliation(s)
- Iwan Paolucci
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA
| | - Jessica Albuquerque Marques Silva
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA
| | - Yuan-Mao Lin
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle A Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudio E Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Ruiz
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jens Tan
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Interventionelle Onkologie-Mikroinvasive Therapie (SIP), Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Bruno C Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA.
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7
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Paolucci I, Bulatović M, Weber S, Tinguely P. Thermal ablation with configurable shapes: a comprehensive, automated model for bespoke tumor treatment. Eur Radiol Exp 2023; 7:67. [PMID: 37932631 PMCID: PMC10628015 DOI: 10.1186/s41747-023-00381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/29/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Malignant tumors routinely present with irregular shapes and complex configurations. The lack of customization to individual tumor shapes and standardization of procedures limits the success and application of thermal ablation. METHODS We introduced an automated treatment model consisting of (i) trajectory and ablation profile planning, (ii) ablation probe insertion, (iii) dynamic energy delivery (including robotically driven control of the energy source power and location over time, according to a treatment plan bespoke to the tumor shape), and (iv) quantitative ablation margin verification. We used a microwave ablation system and a liver phantom (acrylamide polymer with a thermochromic ink) to mimic coagulation and measure the ablation volume. We estimated the ablation width as a function of power and velocity following a probabilistic model. Four representative shapes of liver tumors < 5 cm were selected from two publicly available databases. The ablated specimens were cut along the ablation probe axis and photographed. The shape of the ablated volume was extracted using a color-based segmentation method. RESULTS The uncertainty (standard deviation) of the ablation width increased with increasing power by ± 0.03 mm (95% credible interval [0.02, 0.043]) per watt increase in power and by ± 0.85 mm (95% credible interval [0, 2.5]) per mm/s increase in velocity. Continuous ablation along a straight-line trajectory resulted in elongated rotationally symmetric ablation shapes. Simultaneous regulation of the power and/or translation velocity allowed to modulate the ablation width at specific locations. CONCLUSIONS This study offers the proof-of-principle of the dynamic energy delivery system using ablation shapes from clinical cases of malignant liver tumors. RELEVANCE STATEMENT The proposed automated treatment model could favor the customization and standardization of thermal ablation for complex tumor shapes. KEY POINTS • Current thermal ablation systems are limited to ellipsoidal or spherical shapes. • Dynamic energy delivery produces elongated rotationally symmetric ablation shapes with varying widths. • For complex tumor shapes, multiple customized ablation shapes could be combined.
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Affiliation(s)
- Iwan Paolucci
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Milica Bulatović
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Pascale Tinguely
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
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Couillard AB, Zlevor AM, Ziemlewicz TJ, Kisting MA, Knott E, Rossebo AE, White J, Lubner MG, Gettle LM, Hinshaw JL, Mao L, Stoffregen W, Swietlik JF, Knavel-Koepsel E, Stratchko L, Abel EJ, Xu Z, Lee FT, Laeseke PF. A Comparison of Histotripsy and Percutaneous Cryoablation in a Chronic Healthy Swine Kidney Model. J Vasc Interv Radiol 2023; 34:1986-1996. [PMID: 37481064 DOI: 10.1016/j.jvir.2023.07.014] [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: 02/01/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open
Abstract
PURPOSE To compare the safety and efficacy of histotripsy with cryoablation in a chronic human-scale normal porcine kidney model. MATERIALS AND METHODS Eighteen female domestic swine were divided evenly into histotripsy and cryoablation treatment arms. A planned 2-3 cm diameter treatment was performed under ultrasound (histotripsy) or ultrasound and computed tomography (CT) guidance (cryoablation). Contrast-enhanced CT and serum blood analysis were performed immediately postprocedure and on day 7, with either immediate killing (n = 3) or continued survival to day 30 (n = 6), at which time contrast-enhanced CT, serum blood analysis, and necropsy were performed. Animal welfare, treatment zone appearance, procedure-related adverse events, and histopathology of the treatment zones and surrounding tissues were assessed. RESULTS Histotripsy treatment zones (mean ±standard deviation diameters, 2.7 ± 0.12 × 2.4 ± 0.19 × 2.4 ± 0.26 cm; volume, 8.3 ± 1.9 cm3) were larger than cryoablation zones (mean diameters, 2.2 ± 0.19 × 1.9 ± 0.13 × 1.7 ± 0.19 cm; volume, 3.9 ± 0.8 cm3; P < .001). At 30 days, histotripsy and cryoablation treatment zone volumes decreased by 96% and 83% on CT, respectively (P < .001). Perirenal hematomas were present after 8 of 9 (89%) cryoablation (mean volume, 22.2 cm3) and 1 of 9 (11%, P < .001) histotripsy (volume, 0.4 cm3) procedures, with active arterial extravasation in 4 of 9 (44%) cryoablation and no histotripsy animals (P = .206). All 9 histotripsy animals and 5 of 9 (56%) cryoablation animals had collecting system debris (P = .042). Changes in serum creatinine were similar between the groups (P = .321). CONCLUSIONS Other than a higher rate of bleeding after cryoablation, the safety and early efficacy of histotripsy and cryoablation were comparable for creating treatment zones in a chronic normal porcine kidney model.
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Affiliation(s)
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Emily Knott
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jim White
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - John F Swietlik
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Lindsay Stratchko
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - E Jason Abel
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
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Johnston EW, Basso J, Silva F, Haris A, Jones RL, Khan N, Lawrence H, Mathiszig-Lee J, McCall J, Cunningham DC, Fotiadis N. Robotic versus freehand CT-guided radiofrequency ablation of pulmonary metastases: a comparative cohort study. Int J Comput Assist Radiol Surg 2023; 18:1819-1828. [PMID: 37072657 PMCID: PMC10497639 DOI: 10.1007/s11548-023-02895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Radiofrequency ablation (RFA) is a curative treatment option for small lung metastases, which conventionally involves multiple freehand manipulations until the treating electrode is satisfactorily positioned. Stereotactic and robotic guidance has been gaining popularity for liver ablation, although has not been established in lung ablation. The purpose of this study is to determine the feasibility, safety, and accuracy of robotic RFA for pulmonary metastases, and compare procedures with a conventional freehand cohort. METHODS A single center study with prospective robotic cohort, and retrospective freehand cohort. RFA was performed under general anesthesia using high frequency jet ventilation and CT guidance. Main outcomes were (i) feasibility/technical success (ii) safety using Common Terminology Criteria for Adverse Events (iii) targeting accuracy (iv) number of needle manipulations for satisfactory ablation. Robotic and freehand cohorts were compared using Mann-Whitney U tests for continuous variables, and Fisher's exact for categorical variables. RESULTS Thirty-nine patients (mean age 65 ± 13 years, 20 men) underwent ablation of 44 pulmonary metastases at single specialist cancer center between July 2019 and August 2022. 20 consecutive participants underwent robotic ablation, and 20 consecutive patients underwent freehand ablation. All 20/20 (100%) robotic procedures were technically successful, and none were converted to freehand procedures. There were 6/20 (30%) adverse events in the robotic cohort, and 15/20 (75%) in the freehand cohort (P = 0.01). Robotic placement was highly accurate with 6 mm tip-to-target distance (range 0-14 mm) despite out-of-plane approaches, with fewer manipulations than freehand placement (median 0 vs. 4.5 manipulations, P < 0.001 and 7/22, 32% vs. 22/22, 100%, P < 0.001). CONCLUSIONS Robotic radiofrequency ablation of pulmonary metastases with general anesthesia and high frequency jet ventilation is feasible and safe. Targeting accuracy is high, and fewer needle/electrode manipulations are required to achieve a satisfactory position for ablation than freehand placement, with early indications of reduced complications.
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Affiliation(s)
- Edward W Johnston
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK.
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK.
| | - Jodie Basso
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Francisca Silva
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Arafat Haris
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Robin L Jones
- Sarcoma Unit, Medical Oncology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK
| | - Nasir Khan
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Helen Lawrence
- Department of Anaesthesia and Perioperative Medicine, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Jakob Mathiszig-Lee
- Department of Anaesthesia and Perioperative Medicine, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - James McCall
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - David C Cunningham
- Gastrointestinal Unit, Medical Oncology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK
| | - Nicos Fotiadis
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK.
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK.
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Koza A, Bhogal RH, Fotiadis N, Mavroeidis VK. The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes. Biomedicines 2023; 11:biomedicines11041062. [PMID: 37189680 DOI: 10.3390/biomedicines11041062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.
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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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Shang Y, Li G, Zhang B, Wu Y, Chen Y, Li C, Zhao W, Liu J. Image-guided percutaneous ablation for lung malignancies. Front Oncol 2022; 12:1020296. [PMID: 36439490 PMCID: PMC9685331 DOI: 10.3389/fonc.2022.1020296] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/19/2022] [Indexed: 10/21/2023] Open
Abstract
Image-guided percutaneous lung ablation has proven to be an alternative and effective strategy in the treatment of lung cancer and other lung malignancies. Radiofrequency ablation, microwave ablation, and cryoablation are widely used ablation modalities in clinical practice that can be performed along or combined with other treatment modalities. In this context, this article will review the application of different ablation strategies in lung malignancies.
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Affiliation(s)
- Youlan Shang
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Ge Li
- Xiangya Hospital, Central South University, Changsha, China
| | - Bin Zhang
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuzhi Wu
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanjing Chen
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Chang Li
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhao
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Liu
- Second Xiangya Hospital, Central South University, Changsha, China
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Sebek J, Cappiello G, Rahmani G, Zeinali N, Keating M, Fayemiwo M, Harkin J, McDaid L, Gardiner B, Sheppard D, Senanayake R, Gurnell M, O’Halloran M, Dennedy MC, Prakash P. Image-based computer modeling assessment of microwave ablation for treatment of adrenal tumors. Int J Hyperthermia 2022; 39:1264-1275. [PMID: 36137605 PMCID: PMC9820798 DOI: 10.1080/02656736.2022.2125590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To assess the feasibility of delivering microwave ablation for targeted treatment of aldosterone producing adenomas using image-based computational models. METHODS We curated an anonymized dataset of diagnostic 11C-metomidate PET/CT images of 14 patients with aldosterone producing adenomas (APA). A semi-automated approach was developed to segment the APA, adrenal gland, and adjacent organs within 2 cm of the APA boundary. The segmented volumes were used to implement patient-specific 3D electromagnetic-bioheat transfer models of microwave ablation with a 2.45 GHz directional microwave ablation applicator. Ablation profiles were quantitatively assessed based on the extent of the APA target encompassed by an ablative thermal dose, while limiting thermal damage to the adjacent normal adrenal tissue and sensitive critical structures. RESULTS Across the 14 patients, adrenal tumor volumes ranged between 393 mm3 and 2,395 mm3. On average, 70% of the adrenal tumor volumes received an ablative thermal dose of 240CEM43, while limiting thermal damage to non-target structures, and thermally sparing 83.5-96.4% of normal adrenal gland. Average ablation duration was 293 s (range: 60-600 s). Simulations indicated coverage of the APA with an ablative dose was limited when the axis of the ablation applicator was not well aligned with the major axis of the targeted APA. CONCLUSIONS Image-based computational models demonstrate the potential for delivering microwave ablation to APA targets within the adrenal gland, while limiting thermal damage to surrounding non-target structures.
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Affiliation(s)
- Jan Sebek
- Mike Wiegers Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA
| | - Grazia Cappiello
- Translational Medical Devices Lab, National University of Ireland, Galway, Republic of Ireland
| | - George Rahmani
- Department of Radiology, Galway University Hospitals, Galway, Republic Ireland
| | - Nooshin Zeinali
- Mike Wiegers Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA
| | - Muireann Keating
- School of Medicine, National University of Ireland, Galway, Republic Ireland
| | - Michael Fayemiwo
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Jim Harkin
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Liam McDaid
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Bryan Gardiner
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Declan Sheppard
- Department of Radiology, Galway University Hospitals, Galway, Republic Ireland
| | | | - Mark Gurnell
- Institute of Metabolic Science, University of Cambridge, United Kingdom
| | - Martin O’Halloran
- Translational Medical Devices Lab, National University of Ireland, Galway, Republic of Ireland
| | - M. Conall Dennedy
- School of Medicine, National University of Ireland, Galway, Republic Ireland
| | - Punit Prakash
- Mike Wiegers Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA.,Author to whom correspondence should be addressed: Punit Prakash, 3078 Engineering Hall, 1701D Platt St, Kansas State University, Manhattan, KS 66506, USA.
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Ruiter SJS, Tinguely P, Paolucci I, Engstrand J, Candinas D, Weber S, de Haas RJ, de Jong KP, Freedman J. 3D Quantitative Ablation Margins for Prediction of Ablation Site Recurrence After Stereotactic Image-Guided Microwave Ablation of Colorectal Liver Metastases: A Multicenter Study. Front Oncol 2021; 11:757167. [PMID: 34868968 PMCID: PMC8634106 DOI: 10.3389/fonc.2021.757167] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 01/29/2023] Open
Abstract
Background Three-dimensional (3D) volumetric ablation margin assessment after thermal ablation of liver tumors using software has been described, but its predictive value on treatment efficacy when accounting for other factors known to correlate ablation site recurrence (ASR) remains unknown. Purpose To investigate 3D quantitative ablation margins (3D-QAMs) as an algorithm to predict ASR within 1 year after stereotactic microwave ablation (SMWA) for colorectal liver metastases (CRLM). Materials and Methods Sixty-five tumors in 47 patients from a prospective multicenter study of patients undergoing SMWA for CRLM were included in this retrospective 3D-QAM analysis. Using a previously developed algorithm, 3D-QAM defined as the distribution of tumor to ablation surface distances was assessed in co-registered pre- and post-ablation CT scans. The discriminatory power and optimal cutoff values for 3D-QAM were assessed using receiver operating characteristic (ROC) curves. Multivariable logistic regression analysis using generalized estimating equations was applied to investigate the impact of various 3D-QAM outputs on 1-year ASR while accounting for other known influencing factors. Results Ten of the 65 (15.4%) tumors included for 3D-QAM analysis developed ASR. ROC analyses identified i) 3D-QAM <1 mm for >23% of the tumor surface, ii) 3D-QAM <5 mm for >45%, and iii) the minimal ablation margin (MAM) as the 3D-QAM outputs with optimal discriminatory qualities. The multivariable regression model without 3D-QAM yielded tumor diameter and KRAS mutation as 1-year ASR predictors. When adding 3D-QAM, this factor became the main predictor of 1-year ASR [odds ratio (OR) 21.67 (CI 2.48, 165.21) if defined as >23% <1 mm; OR 0.52 (CI 0.29, 0.95) if defined as MAM]. Conclusions 3D-QAM allows objectifiable and standardized assessment of tumor coverage by the ablation zone after SMWA. Our data shows that 3D-QAM represents the most important factor predicting ASR within 1 year after SMWA of CRLM.
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Affiliation(s)
- Simeon J S Ruiter
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Pascale Tinguely
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.,Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Iwan Paolucci
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Robbert J de Haas
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
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