Robot-assisted thoracoscopic brachytherapy for lung cancer: Comparison of the ZEUS robot, VATS, and manual seed implantation

A new multimodal, image-guided, robot-assisted, interstitial brachytherapy for the treatment of head and neck tumors-A preliminary study

BACKGROUND

Interstitial brachytherapy (BT) is becoming an accepted treatment option for head and neck cancer patients for whom surgery poses high risks. Multimodal, image-guided, robotic surgery has the potential to allow precise seed implantation into tumors. Our aim was to introduce a new multimodal, image-guided surgical robot during the performance of interstitial BT for the treatment of tumors in the head and neck regions.

METHODS

Clinical data for three patients were analyzed, retrospectively; patients had received ¹²⁵ I seed implantations from July 2019 to October 2019. Multimodal, image-guided, robotic surgery was performed in all patients. Postoperative computed tomography data were imported to software to evaluate the accuracy of the seed position and the operation times.

RESULTS

The mean placement error of the ¹²⁵ I seed was 1.9 ± 0.74 mm. The mean operation time is 47 minutes.

CONCLUSION

The experimental results showed that the Remebot has promise for use during BT for the head and neck.

Prospect of robotic assistance for fully automated brachytherapy seed placement into skull base: Experimental validation in phantom and cadaver

BACKGROUND AND PURPOSE

To investigate the feasibility and accuracy of robot-assisted brachytherapy for skull base tumours.

MATERIAL AND METHODS

A custom robot system was tested on both phantom and cadaveric specimen. Cone beam CT (CBCT) images were transferred to the graphical user interface (GUI) for planning trajectories and the data were sent to the robot control unit. Following registration, the puncture needle was inserted into the target by the robot under navigation guidance, and seeds were implanted. Placement error was instantly displayed on the GUI; the result was verified after postoperative image scanning.

RESULTS

A total of 150 seeds (100 for phantom experiments, 50 for cadaveric studies) were deposited by the robot system. In phantom experiments the mean placement error was 0.57 ± 0.21 mm (measured by the navigation system) vs. 1.41 ± 0.38 mm (measured by image fusion) (p < 0.001); in cadaveric studies the corresponding figures were 0.60 ± 0.30 mm vs. 2.48 ± 0.32 mm (p < 0.001). There was no significant difference for comparison of accuracy test in phantom experiments (p = 0.173) as well as in cadaveric studies (p = 0.354). Accuracy was better in the phantom experiment than in cadaveric studies (p < 0.001).

CONCLUSIONS

The performance of robot-assisted skull base brachytherapy is feasible and accurate. Dosimetric coverage will need to be demonstrated in further studies.

Chinese Expert Consensus Workshop Report: Guideline for permanent iodine-125 seed implantation of primary and metastatic lung tumors

Surgery remains the first choice of cure for early stage lung cancer. However, many patients are diagnosed at advanced stage, and thus miss the opportunity to undergo surgery. As such patients derive limited benefits from chemotherapy or radiotherapy, alternatives focusing on local control have emerged, including iodine‐125 seed implantation. The Interstitial Brachytherapy Society, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti‐Cancer Association organized a group of multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim to standardize iodine‐125 seed implantation procedures, inclusion criteria, and outcome assessment to prevent and manage procedure‐related complications.

Electromagnetic navigation improves minimally invasive robot-assisted lung brachytherapy

OBJECTIVE

Recent advances in minimally invasive thoracic surgery have renewed an interest in the role of interstitial brachytherapy for lung cancer. Our previous work has demonstrated that a minimally invasive robot-assisted (MIRA) lung brachytherapy system produced results that were equal to or better than those obtained with standard video-assisted thoracic surgery (VATS) and comparable to results with open surgery. The purpose of this project was to evaluate the performance of an integrated system for MIRA lung brachytherapy that incorporated modified electromagnetic navigation and ultrasound image guidance with robotic assistance.

METHODS

The experimental test-bed consisted of a VATS box, ZEUS and AESOP surgical robotic arms, a seed injector, an ultrasound machine, video monitors, a computer, and an endoscope. Our previous custom-designed electromagnetic navigational software and the robotic controller were modified and incorporated into the MIRA III system to become the next-generation MIRA IV. Inactive brachytherapy seeds were injected as close as possible to a small metal ball target embedded in an opaque agar cube. The completion time, the number of attempts, and the accuracy of seed deployment were compared for manual placement, standard VATS, MIRA III, and the new MIRA IV system.

RESULTS

The MIRA IV system significantly reduced the median procedure time by 61% (104 s to 41 s), tissue trauma by 75% (4 attempts to 1 attempt), and mean seed placement error by 64% (2.5 mm to 0.9 mm) when compared to a standard VATS. MIRA IV also reduced the mean procedure time by 48% (85 s to 44 s) and the seed placement error by 68% (2.8 mm to 0.9 mm) compared to the MIRA III system.

CONCLUSIONS

A modified integrated system for performing minimally invasive robot-assisted lung brachytherapy was developed that incorporated electromagnetic navigation and an improved robotic controller. The MIRA IV system performed significantly better than standard VATS and better than MIRA III.