Preliminary clinical application of the robot-assisted CT-guided irreversible electroporation ablation for the treatment of pancreatic head carcinoma

IRE made easy: introducing the robotic grid system for multiple parallel needle insertion in irreversible electroporation treatment

PURPOSE

Accurate needle placement is crucial for successful tumor treatment using the irreversible electroporation (IRE) method. Multiple needles are inserted around the tumor, ideally in parallel, to achieve uniform electric field distribution. This paper presents a robot utilizing a grid system to enable multiple needles insertion while maintaining parallelism between them.

METHODS

The robotic system has two degrees of freedom, which allow for the adjustment of the grid system to accommodate targeting lesions in various positions. The robot's performance was evaluated by testing its accuracy across various configurations and target depth locations, as well as its ability to maintain the needle parallelism.

RESULTS

The robot has dimensions of ϕ 134 mm and a height of 46 mm, with a total weight of 295 g. The system accuracy test showed that the robot can precisely target points across different target depths and needle orientations, with an average error of 2.71 ± 0.68 mm. Moreover, multiple insertions at different grid locations reveal needle orientation deviations typically below 1 ∘ .

CONCLUSION

This study presented the design and validation of a robotic grid system. The robot is capable of maintaining insertion accuracy and needle parallelism during multiple needle insertions at various robot configurations. The robot showed promising results with limited needle deviation, making it suitable for IRE procedures.

Low-dose CT fluoroscopy-guided interventional minimally invasive robot

Background

This study aimed to assess the feasibility, safety, and accuracy of a low-dose CT fluoroscopy-guided remote-controlled robotic real-time puncture procedure.

Methods

The study involved two control groups with Taguchi method: Group A, which underwent low-dose traditional CT-guided manual puncture (blank control), and Group B, which underwent conditional control puncture. Additionally, an experimental group, Group C, underwent CT fluoroscopy-guided remote-controlled robotic real-time puncture. In a phantom experiment, various simulated targets were punctured, while in an animal experiment, attempts were made to puncture targets in different organs of four pigs. The number of needle adjustments, puncture time, total puncture operation time, and radiation dose were analyzed to evaluate the robot system.

Results

Successful punctures were achieved for each target, and no complications were observed. Dates were calculated for all parameters using Taguchi method.

Conclusion

The low-dose CT fluoroscopy-guided puncture robot system is a safe, feasible, and equally accurate alternative to traditional manual puncture procedures.

Evaluation of a New CT-Guided Robotic System for Percutaneous Needle Insertion for Thermal Ablation of Liver Tumors: A Prospective Pilot Study

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.

Modeling of a single bipolar electrode with tines for irreversible electroporation delivery

Irreversible electroporation (IRE) is a non-thermal tumor ablation technology employed to treat solid tumors not amenable to resection or thermal ablation. The IRE systems currently in clinical use deliver electrical pulses via multiple monopolar electrodes. This approach can present significant technical challenges due to the requirement for accurate placement of multiple electrodes and maintenance of parallel electrode alignment during pulse delivery. In this study, we sought to evaluate a novel IRE electrode configuration consisting of a single bipolar electrode with deployable tines. Using commercial finite element software predicted ablation outcomes, thermal damage, ablation sphericity, and energy delivery were calculated for existing monopolar and bipolar electrodes, and bipolar electrodes with either 4 or 8 deployable tines. The bipolar electrodes with tines generated larger predicted ablations compared to existing monopolar (>100%) and bipolar (>10%) arrangements, and the ablation shape using bipolar electrodes with tines were more spherical than those modeled for bipolar electrodes. Thermal damage modeled for bipolar electrodes and bipolar electrodes with tines was less than that of monopolar electrodes (using identical pulse parameters), and bipolar electrodes with tines delivered less energy than monopolar or bipolar electrodes. These studies using a single point of device insertion suggest the potential for developing alternative IRE delivery techniques, and may simplify clinical use and increase the predicted ablation shape/volume.