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

Evaluation of navigation and robotic systems for percutaneous image-guided interventions: A novel metric for advanced imaging and artificial intelligence integration

PURPOSE

Navigation and robotic systems aim to improve the accuracy and efficiency of percutaneous image-guided interventions, but the evaluation of their autonomy and integration of advanced imaging and artificial intelligence (AI) is lacking. The purpose of this study was to evaluate the level of automation and integration of advanced imaging and artificial intelligence in navigation and robotic systems for percutaneous image-guided interventions, using established and novel metrics to categorize and compare their capabilities.

MATERIALS AND METHODS

Following PRISMA guidelines, a systematic review was conducted to identify studies on clinically validated navigation and robotic systems published between 2000 and May 2024. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data on navigation devices were extracted and analyzed. The levels of autonomy in surgical robotics (LASR) classification system (from 1 to 5) was used to analyze automation. A novel taxonomy, the Levels of Integration of Advanced Imaging and AI (LIAI2) classification system, was created to categorize the integration of imaging technologies and AI (from 1 to 5). These two scores were combined into an aggregate score (from 1 to 10) to reflect the autonomy in percutaneous image-guided intervention.

RESULTS

The review included 20 studies assessing two navigation systems and eight robotic devices. The median LASR score was 1 (Q1, Q3: 1, 1), the median LIAI2 score was 2 (Q1, Q3: 2, 3), and the median aggregate score was 3 (Q1, Q3: 3, 4). Only one robotic system (10 % of those reviewed) achieved the highest LASR qualification in the literature, a level 2/5. Four systems (40 %) shared the highest rating for LIAI2, which was a score of 3/5. Four systems (40 %) achieved the highest aggregate scores of 4/10.

CONCLUSION

None of the navigation and robotic systems achieved full autonomy for percutaneous image-guided intervention. The LASR and LIAI2 scales can guide innovation by identifying areas for further development and integration.

Semi-automatic robotic puncture system based on deformable soft tissue point cloud registration

PURPOSE

Traditional surgical puncture robot systems based on computed tomography (CT) and infrared camera guidance have natural disadvantages for puncture of deformable soft tissues such as the liver. Liver movement and deformation caused by breathing are difficult to accurately assess and compensate by current technical solutions. We propose a semi-automatic robotic puncture system based on real-time ultrasound images to solve this problem.

METHOD

Real-time ultrasound images and their spatial position information can be obtained by robot in this system. By recognizing target tissue in these ultrasound images and using reconstruction algorithm, 3D real-time ultrasound tissue point cloud can be constructed. Point cloud of the target tissue in the CT image can be obtained by using developed software. Through the point cloud registration method based on feature points, two point clouds above are registered. The puncture target will be automatically positioned, then robot quickly carries the puncture guide mechanism to the puncture site and guides the puncture. It takes about just tens of seconds from the start of image acquisition to completion of needle insertion. Patient can be controlled by a ventilator to temporarily stop breathing, and patient's breathing state does not need to be the same as taking CT scan.

RESULTS

The average operation time of 24 phantom experiments is 64.5 s, and the average error between the needle tip and the target point after puncture is 0.8 mm. Two animal puncture surgeries were performed, and the results indicated that the puncture errors of these two experiments are 1.76 mm and 1.81 mm, respectively.

CONCLUSION

Robot system can effectively carry out and implement liver tissue puncture surgery, and the success rate of phantom experiments and experiments is 100%. It also shows that the puncture robot system has high puncture accuracy, short operation time, and great clinical value.

The clinical performance of robotic assisted navigation system versus conventional freehand technique for percutaneous transthoracic needle biopsy

This study aimed to assess the feasibility and safety of robotic-assisted navigation system for percutaneous transthoracic needle biopsy (PTNB), compare it with conventional freehand technique, and evaluate its generalizability across operators with varying experience levels. After excluding 5 patients in whom robotic-assisted PTNB could not be performed due to technical problems, a total of 50 patients with robotic-assisted PTNB and 200 patients who performed freehand puncture were included. Using propensity score matching (PSM) to match two groups of patients and simulate a randomized controlled scenario. The results showed that robotic-assisted PTNB significantly reduced the number of punctures, CT scans, and total procedure time (P < 0.05). These reductions were accompanied by a significantly lower rate of pneumothorax (P = 0.05), a common complication in PTNB procedures. While the overall adverse event rates remained similar between the two groups, the robotic-assisted technique demonstrated a more favorable safety profile, particularly with regard to reduced pneumothorax and hemorrhage rates. Additionally, there were no significant differences in the number of punctures, CT scans, total procedure time, and radiation dose administered to patients during robotic-assisted PTNB, irrespective of the operator. This suggests that operator experience does not significantly influence the outcomes of robotic-assisted PTNB, further highlighting the potential of the robotic system to minimize the impact of operator variability. Thus, we think robotic-assisted PTNB is feasible, safe, and less dependent on operator experience, suggesting its potential for clinical promote.

Democratization in abdominal ablation therapies: The impact of percutaneous robotic assistance on accuracy-A systematic review

Advances in medical technology have revolutionized minimally invasive procedures. This study aims to determine the status of intra-abdominal ablation therapies, focusing on outcomes regarding technique improvement and benefits related to the learning curve. A systematic search in four databases was performed in March 2024 to identify relevant studies. Endpoints included targeting accuracy, organ efficacy, safety, outcomes and technical advantages regardless of physician experience. A total of 40 studies were included. The robotic technique demonstrated significantly higher accuracy (median 1.75 mm) compared to the freehand technique (median 4.50 mm) (p < 0.05). RFA and MWA were the most frequently used ablation techniques, reaching a rate of 52.5% and liver was the main target organ in 77.5% of the studies. Subgroup analysis showed a median tumor size of 2.30 cm, 1.40 mm for the readjustments and 3.30 mm for accuracy in the freehand technique. For robotic approach, the median tumor size was 1.95 cm, readjustments were 0.55 mm, and accuracy was 1.85 mm, and no statistical difference was identified. Severe adverse events were lower with the robotic approach, and improvement in the learning curve was observed among novice physicians. Robotic-assisted ablation techniques improve accuracy and efficacy compared to freehand techniques and are easier for novices to use. This technology allows novices to achieve similar outcomes to experts, contributing to the democratization of ablation techniques. Nevertheless, more clinical trials and standardized studies are necessary to validate these findings and enable the integration of robotic systems into routine practice.

Image Guided Percutaneous Robotic Interventions for Solid Organs

Robotic systems for minimally invasive procedures, particularly in interventional oncology, have advanced significantly, especially for percutaneous interventions guided by CT, Cone-beam CT, and MRI. These systems, which include needle-guiding and needle-driving robots, enhance the precision of procedures like biopsy and tumor ablation. Needle-guiding robots plan and align the needle, while needle-driving robots autonomously advance it, improving needle placement accuracy, enabling out-of-plane insertion, and reducing radiation exposure. These robotic systems offer key clinical benefits, such as stable needle guidance for challenging angulated approaches and better access to lesions in confined spaces, like CT or MRI gantries. They can guide the needle to the optimal region of a lesion without the need for a second contrast injection, improving both diagnosis and treatment. While many robotic systems have been developed, only a few have reached clinical use. Early studies show promising results, but concerns about increased complexity and cost remain. Further research and clinical trials are needed to fully evaluate their value, though we believe that robotic systems will play an increasingly important role in the future of image-guided interventions, particularly for challenging tumors.

Needle Tip Tracking through Photoluminescence for Minimally Invasive Surgery

Minimally invasive surgery continues to prioritize patient safety by improving imaging techniques and tumor detection methods. In this work, an all-optical alternative to the current image based techniques for in vitro minimally invasive procedures has been explored. The technique uses a highly fluorescent marker for the surgical needle to be tracked inside simulated tissues. A series of markers were explored including inorganic (Perovskite and PbS) and organic (carbon dots) nanoparticles and organic dye (Rhodamine 6G) to identify layers of different stiffnesses within a tissue. Rhodamine 6G was chosen based on its high fluorescence signal to track 3D position of a surgical needle in a tissue. The needle was tracked inside homogeneous and inhomogeneous gelatin tissues successfully. This exploratory study of tissue characterization and needle tip tracking using fluorescent markers or photoluminescence technique show potential for real-time application of robot-assisted needle insertions during in vivo procedures.

Evaluation of robotic-assisted navigation system for CT-guided thoracic and abdominal lesion puncture: A prospective clinical study

INTRODUCTION

The study aims to compare the accuracy and safety of robotic-assisted navigation puncture to freehand puncture during computed tomography (CT)-guided percutaneous needle insertion in the chest and abdomen.

METHODS

A total of 60 patients required percutaneous puncture procedures, with 40 involving the chest and 20 involving the abdomen. Eligible patients were randomly assigned to two groups. The test group punctured using a robotic-assisted navigation system, whereas the control group punctured manually. The primary outcome assessment standards are single puncture success rates, with the number of needle modifications and CT scan timings during the procedure serving as supplementary outcome evaluation standards. The Wilcoxon rank sum test is used for the comparison.

RESULTS

The puncture procedure's success rates after just one puncture: The test group punctures accurately without adjusting the puncture needle, while the control group uses an average number of 1.73 ± 1.20 pins. The once-puncture success rate of robot navigation puncture is considerably higher than that of bare-handed puncture (P < 0.001). The times of CT scan are necessitated when the puncture is in place: the average times in the test group is 3.03 ± 0.18 times, while the control group is 4.70 ± 1.24 times.

CONCLUSION

In conclusion, the robotic-assisted navigation system improves puncture accuracy while reducing the need for needle corrections during percutaneous puncture procedures. It also shortens CT scans and reduces radiation exposure from X-rays.

Review of robotic systems for thoracoabdominal puncture interventional surgery

Cancer, with high morbidity and high mortality, is one of the major burdens threatening human health globally. Intervention procedures via percutaneous puncture have been widely used by physicians due to its minimally invasive surgical approach. However, traditional manual puncture intervention depends on personal experience and faces challenges in terms of precisely puncture, learning-curve, safety and efficacy. The development of puncture interventional surgery robotic (PISR) systems could alleviate the aforementioned problems to a certain extent. This paper attempts to review the current status and prospective of PISR systems for thoracic and abdominal application. In this review, the key technologies related to the robotics, including spatial registration, positioning navigation, puncture guidance feedback, respiratory motion compensation, and motion control, are discussed in detail.

Robotic-assisted CT-guided percutaneous thermal ablation of abdominal tumors: An analysis of 41 patients

PURPOSE

Robotic assistance is rapidly evolving and may help physicians optimize needle guidance during percutaneous interventions. The purpose of the study was to report feasibility, safety, accuracy, immediate clinical success and short-term local tumor control after robotic-assisted computed tomography (CT)-guided thermal ablation of abdominal tumors.

MATERIALS AND METHODS

Forty-one patients who underwent percutaneous thermal ablation of abdominal tumors using robotic-assisted CT-guided were included. All ablations were performed with robotic assistance, using an optically-monitored robotic system with a needle guide sent to preplanned trajectories defined on three-dimensional-volumetric CT acquisitions with respiration monitoring. Endpoints were technical success, safety, distance from needle tip to planned trajectory and number of needle adjustments, and complete ablation rate.

RESULTS

Forty-one patients (31 men; mean age, 66.7 ± 9.9 [standard deviation (SD)] years [age range: 41-84 years]) were treated for 48 abdominal tumors, with 79 planned needles. Lesions treated were located in the liver (23/41; 56%), kidney (14/41;34%), adrenal gland (3/41; 7%) or retroperitoneum (1/41; 2%). Technical success was achieved in 39/41 (95%) patients, and 76/79 (96%) needle insertions. The mean lateral distance between the needle tip and planned trajectory was 3.2 ± 4.5 (SD) mm (range: 0-20 mm) before adjustments, and the mean three-dimensional distance was 1.6 ± 2.6 (SD) mm (range: 0-13 mm) after 29 manual depth adjustments (29/78; 37%) and 33 lateral adjustments (33/78; 42%). Two (2/79; 3%) needles required complete manual reinsertion. One grade 3 complication was reported in one patient (1/41; 2%). The overall clinical success rate was 100%. The 3-month local tumor control rate (progression free survival) was 95% (38/41).

CONCLUSION

These results provide further evidence on the use of robotic-assisted needle insertion regarding feasibility, safety, and accuracy, resulting in effective percutaneous thermal ablation of abdominal tumors.

Innovations in Image-Guided Procedures: Unraveling Robot-Assisted Non-Hepatic Percutaneous Ablation

Interventional oncology is routinely tasked with the feat of tumor characterization or destruction, via image-guided biopsy and tumor ablation, which may pose difficulties due to challenging-to-reach structures, target complexity, and proximity to critical structures. Such procedures carry a risk-to-benefit ratio along with measurable radiation exposure. To streamline the complexity and inherent variability of these interventions, various systems, including table-, floor-, gantry-, and patient-mounted (semi-) automatic robotic aiming devices, have been developed to decrease human error and interoperator and intraoperator outcome variability. Their implementation in clinical practice holds promise for enhancing lesion targeting, increasing accuracy and technical success rates, reducing procedure duration and radiation exposure, enhancing standardization of the field, and ultimately improving patient outcomes. This narrative review collates evidence regarding robotic tools and their implementation in interventional oncology, focusing on clinical efficacy and safety for nonhepatic malignancies.

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.

Model-free control for autonomous prevention of adverse events in robotics

Introduction: Preventive control is a critical feature in autonomous technology to ensure safe system operations. One application where safety is most important is robot-assisted needle interventions. During incisions into a tissue, adverse events such as mechanical buckling of the needle shaft and tissue displacements can occur on encounter with stiff membranes causing potential damage to the organ. Methods: To prevent these events before they occur, we propose a new control subroutine that autonomously chooses a) a reactive mechanism to stop the insertion procedure when a needle buckling or a severe tissue displacement event is predicted and b) an adaptive mechanism to continue the insertion procedure through needle steering control when a mild tissue displacement is detected. The subroutine is developed using a model-free control technique due to the nonlinearities of the unknown needle-tissue dynamics. First, an improved version of the model-free adaptive control (IMFAC) is developed by computing a fast time-varying partial pseudo derivative analytically from the dynamic linearization equation to enhance output convergence and robustness against external disturbances. Results and Discussion: Comparing IMFAC and MFAC algorithms on simulated nonlinear systems in MATLAB, IMFAC shows 20% faster output convergence against arbitrary disturbances. Next, IMFAC is integrated with event prediction algorithms from prior work to prevent adverse events during needle insertions in real time. Needle insertions in gelatin tissues with known environments show successful prevention of needle buckling and tissue displacement events. Needle insertions in biological tissues with unknown environments are performed using live fluoroscopic imaging as ground truth to verify timely prevention of adverse events. Finally, statistical ANOVA analysis on all insertion data shows the robustness of the prevention algorithm to various needles and tissue environments. Overall, the success rate of preventing adverse events in needle insertions through adaptive and reactive control was 95%, which is important toward achieving safety in robotic needle interventions.

New Developments in Image-Guided Percutaneous Irreversible Electroporation of Solid Tumors

PURPOSE OF REVIEW

This review will describe the various applications, benefits, risks, and approaches of conventional irreversible electroporation (IRE), as well as highlight the new technological developments of this procedure along with their clinical applications.

RECENT FINDINGS

Minimally invasive image-guided percutaneous IRE ablation has emerged as a newer, non-thermal ablation technique for tumors in the solid organs, particularly within the liver, pancreas, kidney, and prostate. IRE allows for ablation near heat-sensitive structures, including major blood vessels and nerves, and is not susceptible to the heat sink effect. However, it is limited by certain requirements, such as the need for precise parallel placement of at least two probes with a maximum inter-probe distance of 2.5 cm to reduce the risk of arching phenomenon, the requirement for general anesthesia with muscle relaxant, and the need for cardiac synchronization. However, new technological advancements in the ablation system and image guidance tools have been introduced to improve the efficiency and efficacy of IRE. IRE is a safe and effective treatment option for solid tumor ablation within the liver, pancreas, kidney, and prostate. Compared with other ablation techniques, IRE has several advantages, such as the absence of heat sink effect and minimal injury to blood vessels and bile ducts while activating the immune system. Novel techniques such as H-FIRE, needle placement systems, and robotics have enhanced the accuracy and performance in placement of IRE probes. IRE can be especially beneficial when combined with chemotherapy, immunomodulation, and immunotherapy.

Application of Medical Image Navigation Technology in Minimally Invasive Puncture Robot

Microneedle puncture is a standard minimally invasive treatment and surgical method, which is widely used in extracting blood, tissues, and their secretions for pathological examination, needle-puncture-directed drug therapy, local anaesthesia, microwave ablation needle therapy, radiotherapy, and other procedures. The use of robots for microneedle puncture has become a worldwide research hotspot, and medical imaging navigation technology plays an essential role in preoperative robotic puncture path planning, intraoperative assisted puncture, and surgical efficacy detection. This paper introduces medical imaging technology and minimally invasive puncture robots, reviews the current status of research on the application of medical imaging navigation technology in minimally invasive puncture robots, and points out its future development trends and challenges.

Bridging the simulation-to-real gap for AI-based needle and target detection in robot-assisted ultrasound-guided interventions

BACKGROUND

Artificial intelligence (AI)-powered, robot-assisted, and ultrasound (US)-guided interventional radiology has the potential to increase the efficacy and cost-efficiency of interventional procedures while improving postsurgical outcomes and reducing the burden for medical personnel.

METHODS

To overcome the lack of available clinical data needed to train state-of-the-art AI models, we propose a novel approach for generating synthetic ultrasound data from real, clinical preoperative three-dimensional (3D) data of different imaging modalities. With the synthetic data, we trained a deep learning-based detection algorithm for the localization of needle tip and target anatomy in US images. We validated our models on real, in vitro US data.

RESULTS

The resulting models generalize well to unseen synthetic data and experimental in vitro data making the proposed approach a promising method to create AI-based models for applications of needle and target detection in minimally invasive US-guided procedures. Moreover, we show that by one-time calibration of the US and robot coordinate frames, our tracking algorithm can be used to accurately fine-position the robot in reach of the target based on 2D US images alone.

CONCLUSIONS

The proposed data generation approach is sufficient to bridge the simulation-to-real gap and has the potential to overcome data paucity challenges in interventional radiology. The proposed AI-based detection algorithm shows very promising results in terms of accuracy and frame rate.

RELEVANCE STATEMENT

This approach can facilitate the development of next-generation AI algorithms for patient anatomy detection and needle tracking in US and their application to robotics.

KEY POINTS

• AI-based methods show promise for needle and target detection in US-guided interventions. • Publicly available, annotated datasets for training AI models are limited. • Synthetic, clinical-like US data can be generated from magnetic resonance or computed tomography data. • Models trained with synthetic US data generalize well to real in vitro US data. • Target detection with an AI model can be used for fine positioning of the robot.

Current State of Robotics in Interventional Radiology

As a relatively new specialty with a minimally invasive nature, the field of interventional radiology is rapidly growing. Although the application of robotic systems in this field shows great promise, such as with increased precision, accuracy, and safety, as well as reduced radiation dose and potential for teleoperated procedures, the progression of these technologies has been slow. This is partly due to the complex equipment with complicated setup procedures, the disruption to theatre flow, the high costs, as well as some device limitations, such as lack of haptic feedback. To further assess these robotic technologies, more evidence of their performance and cost-effectiveness is needed before their widespread adoption within the field. In this review, we summarise the current progress of robotic systems that have been investigated for use in vascular and non-vascular interventions.

A systematic review of image-guided, surgical robot-assisted percutaneous puncture: Challenges and benefits

Percutaneous puncture is a common medical procedure that involves accessing an internal organ or tissue through the skin. Image guidance and surgical robots have been increasingly used to assist with percutaneous procedures, but the challenges and benefits of these technologies have not been thoroughly explored. The aims of this systematic review are to furnish an overview of the challenges and benefits of image-guided, surgical robot-assisted percutaneous puncture and to provide evidence on this approach. We searched several electronic databases for studies on image-guided, surgical robot-assisted percutaneous punctures published between January 2018 and December 2022. The final analysis refers to 53 studies in total. The results of this review suggest that image guidance and surgical robots can improve the accuracy and precision of percutaneous procedures, decrease radiation exposure to patients and medical personnel and lower the risk of complications. However, there are many challenges related to the use of these technologies, such as the integration of the robot and operating room, immature robotic perception, and deviation of needle insertion. In conclusion, image-guided, surgical robot-assisted percutaneous puncture offers many potential benefits, but further research is needed to fully understand the challenges and optimize the utilization of these technologies in clinical practice.

Robot-Assisted Needle Insertion for CT-Guided Puncture: Experimental Study with a Phantom and Animals

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.

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.

Thermal ablation of the most challenging cases of liver metastases

Patient selection for image-guided thermal ablation of liver metastases has to be taken in a multidisciplinary tumor board given the extreme complexity of cancer metastatic disease, and the numerous treatment options offered to oligometastatic patient today.The role of image-guided thermal ablation increases over years in the treatment of liver metastases. In order to fulfill the expected outcomes which are to have a local control rate equivalent to surgery, interventional oncologist have to take every measure that will help when treating most challenging metastases including image guidance, anesthesia, respiration monitoring, ablation technique, confirmation software that can favor positive outcomes, and in some way to render challenging metastases easy to treat.