Evaluation of a robotic system for irreversible electroporation (IRE) of malignant liver tumors: initial results

Beyer, Lukas Philipp; Pregler, Benedikt; Michalik, Katharina; Niessen, Christoph; Dollinger, Marco; Müller, Martina; Schlitt, Hans J.; Stroszczynski, Christian; Wiggermann, Philipp

doi:10.1007/s11548-016-1485-1

Cited by 36 publications

(32 citation statements)

References 21 publications

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“… 18 Coupling with ste-reotactic navigation or optical navigation has been shown to be feasible, and CT guidance is often used for percutaneous IRE treatments. 35 , 36 , 37 However, in situations when the placing of the electrodes cannot follow the treatment plan, e.g , due to tumour growth between imaging and the time of the treatment, poor contrast of the tumour in pre-treatment imaging or unforeseen difficulties in placing the electrodes according to the treatment plan, a tool to verify the coverage of the tumour with sufficient electric fields is important. MRI imaging has been proposed for monitoring the electric field during pulse delivery; however, the clinical application still requires further developments, such as MRI-compatible pulse generators and electrodes.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy

Boc

Edhemović

Kos

et al. 2018

Radiology and Oncology

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BackgroundThe aim of the study was to characterize ultrasonographic (US) findings during and after electrochem-otherapy of liver tumors to determine the actual ablation zone and to verify the coverage of the treated tumor with a sufficiently strong electric field for effective electrochemotherapy.Patients and methodsUS findings from two representative patients that describe immediate and delayed tumor changes after electrochemotherapy of colorectal liver metastases are presented.ResultsThe US findings were interrelated with magnetic resonance imaging (MRI). Electrochemotherapy-treated tumors were exposed to electric pulses based on computational treatment planning. The US findings indicate immediate appearance of hyperechogenic microbubbles along the electrode tracks. Within minutes, the tumors became evenly hyperechogenic, and simultaneously, an oedematous rim was formed presenting as a hypoechogenic formation which persisted for several hours after treatment. The US findings overlapped with computed electric field distribution in the treated tissue, indicating adequate coverage of tumors with sufficiently strong electric field, which may predict an effective treatment outcome.ConclusionsUS provides a tool for assessment of appropriate electrode insertion for intraoperative electrochemo-therapy of liver tumors and assessment of the appropriate coverage of a tumor with a sufficiently strong electric field and can serve as predictor of the response of tumors.

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Section: Discussionmentioning

confidence: 99%

Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy

Boc

Edhemović

Kos

et al. 2018

Radiology and Oncology

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“…When using robot navigation, the initial CT data was sent to the navigation system (Maxio, Perfint Healthcare, Chennai, India). 18,19 The desired ablation area and the antenna entry point were defined using the planning software, and the trajectory was visualized. If necessary, multiple antenna positions were planned with overlapping ablation zones.…”

Section: Navigation System and Thermoablation Proceduresmentioning

confidence: 99%

Improvement of the primary efficacy of microwave ablation of malignant liver tumors by using a robotic navigation system

Schaible

Pregler

Verloh

et al. 2020

Radiology and Oncology

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BackgroundThe aim of the study was to assess the primary efficacy of robot-assisted microwave ablation and compare it to manually guided microwave ablation for percutaneous ablation of liver malignancies.Patients and methodsWe performed a retrospective single center evaluation of microwave ablations of 368 liver tumors in 192 patients (36 female, 156 male, mean age 63 years). One hundred and nineteen ablations were performed between 08/2011 and 03/2014 with manual guidance, whereas 249 ablations were performed between 04/2014 and 11/2018 using robotic guidance. A 6-week follow-up (ultrasound, computed tomography and magnetic resonance imaging) was performed on all patients.ResultsThe primary technique efficacy outcome of the group treated by robotic guidance was significantly higher than that of the manually guided group (88% vs. 76%; p = 0.013). Multiple logistic regression analysis indicated that a small tumor size (≤ 3 cm) and robotic guidance were significant favorable prognostic factors for complete ablation.ConclusionsIn addition to a small tumor size, robotic navigation was a major positive prognostic factor for primary technique efficacy.

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“… 24 Recently, application in IRE interventions was evaluated as well as described below in greater detail. 25 …”

Section: Tracking Systemsmentioning

confidence: 99%

Navigation Systems for Treatment Planning and Execution of Percutaneous Irreversible Electroporation

Fuhrmann

Probst

Wiggermann

et al. 2018

Technol Cancer Res Treat

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The application of navigational systems has the potential to improve percutaneous interventions. The accuracy of ablation probe placement can be increased and radiation doses reduced. Two different types of systems can be distinguished, tracking systems and robotic systems. This review gives an overview of navigation devices for clinical application and summarizes first findings in the implementation of navigation in percutaneous interventions using irreversible electroporation. Because of the high number of navigation systems, this review focuses on commercially available ones.

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Evaluation of a robotic system for irreversible electroporation (IRE) of malignant liver tumors: initial results

Abstract: Robotic assistance for IRE of liver tumors allows for faster procedure times with higher accuracy while reducing radiation dose as compared to the manual placement of IRE probes.

Cited by 36 publications

References 21 publications

Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy

Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy

Improvement of the primary efficacy of microwave ablation of malignant liver tumors by using a robotic navigation system

Navigation Systems for Treatment Planning and Execution of Percutaneous Irreversible Electroporation

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