Closed-Loop Active Compensation for Needle Deflection and Target Shift During Cooperatively Controlled Robotic Needle Insertion

Abstract

Intra-operative imaging is sometimes available to assist needle biopsy, but typical open-loop insertion does not account for unmodeled needle deflection or target shift. Closed-loop image-guided compensation for deviation from an initial straight-line trajectory through rotational control of an asymmetric tip can reduce targeting error. Incorporating robotic closed-loop control often reduces physician interaction with the patient, but by pairing closed-loop trajectory compensation with hands-on cooperatively controlled insertion, a physician's control of the procedure can be maintained while incorporating benefits of robotic accuracy. A series of needle insertions were performed with a typical 18G needle using closed-loop active compensation under both fully autonomous and user-directed cooperative control. We demonstrated equivalent improvement in accuracy while maintaining physician-in-the-loop control with no statistically significant difference (p > 0.05) in the targeting accuracy between any pair of autonomous or individual cooperative sets, with average targeting accuracy of 3.56 mm. With cooperatively controlled insertions and target shift between 1 and 10 mm introduced upon needle contact, the system was able to effectively compensate up to the point where error approached a maximum curvature governed by bending mechanics. These results show closed-loop active compensation can enhance targeting accuracy, and that the improvement can be maintained under user directed cooperative insertion.

Lung and Abdominal Biopsies in the Age of Precision Medicine

“…Regardless of the technique, preprocedural planning will likely utilize 3D models and motion planning algorithms to plan paths through an individual patient's anatomy along with integration of robotic systems. 41,[44][45][46] In addition, as these technologies mature, strong relationships must be maintained between the researchers, engineers, and clinicians as special considerations must be made because these techniques are paired with different imaging modalities and applied to clinical practice. 41…”

“…52,53 In addition, different pulse sequences can be used to distinguish pathology and identify the most relevant portions of a lesion to biopsy (i.e., areas of necrosis on T2-weighted images). 54 This approach has been shown not only to be feasible, but also to have excellent safety and diagnostic yield in the brain, 44,[55][56][57] percutaneous interventions in the chest, abdomen, and pelvis, [58][59][60][61][62] and even ablative therapy. 63,64 Currently, as this technology is brought to market, these robot functionalities and techniques are being refined and incorporated into workflow.…”

Design of haptic guides for pre-positioning assistance of a comanipulated needle

“…However, those haptic cues do not provide indications about the location of the target. Wartenberg et al [13] present a robotic assistance device for prostate interventions involving the insertion of a beveled-tip needle. With this approach, needle pre-positioning and preorienting on the entry point are automatically controlled by the system.…”

“…Though, with those devices, the assistance of manual needle pre-insertion is only image-based, which requires the user to keep an eye on a screen at all times. Some automatic preinsertion devices also exist, such as the ones presented by Hungr et al [17], Wartenberg et al [13] or the commercial robots NeuroMate TM (Renishaw) [18] and Maxio TM (Perfint Healthcare, India) [19]. However, they do not keep the physician directly in the control loop during this phase of needle insertion and this can result in important acceptability issues for the clinician [20].…”

Medical Robotics

“…A method to ensure a safe intraoperative margin between a drill trajectory and the facial nerve using monopolar and bipolar stimulation threshold measurements during robotic cochlea implantations has been validated during a first-in-man trial. 4 Image guidance may be used to improve targeting accuracy during needle biopsies although it may not account for target or needle displacement, an issue that is addressed by Wartenberg et al 21 An augmented reality system is proposed for computer assisted orthopedic surgery that makes use of a depth sensitive camera for registration purposes, accounting for and avoiding obstacles. 14 Robotic hand-eye calibration is important when moving towards more autonomous actuation, and an improved algorithm to achieve this is proposed and evaluated based on the adjoint transformation of twist motions.…”