Robotic Assisted Radio-Frequency Ablation of Liver Tumors – Randomized Patient Study

Abstract

Abstract. The minimally invasive treatment of liver tumors represents an alternative to the open surgery approach. Radio-frequency ablation destroys a tumor by delivering radio-frequency energy through a needle probe. Traditionally, the probe is placed manually using imaging feedback. New approaches use robotic devices to accurately place the instrument at the target. The authors developed an image-guided robotic system for percutaneous interventions using computed tomography. The paper presents a randomized patient study comparing the manual versus robotic needle placement for radio-frequency ablation procedures of liver tumors. The results of this study show that in our case robotic interventions were a very viable solution. Several treatment parameters such as radiation exposures and procedure-times were found to be significantly improved in the robotic case.

An augmented reality system for liver thermal ablation: Design and evaluation on clinical cases

“…We showed on a static abdominal phantom that the targeting accuracy was about 2.5 mm. Obviously, the patient is not static, yet we believe like others [7,16,6,18] that pseudo-static conditions can be provided using a respiratory gating technique, i.e. the preoperative CT and the computer guidance are realized at the same point of the breathing cycle (generally expiration).…”

“…Concerning the robotized approach, several labs [4][5][6][7][8][9] propose a needle guidance toward a target in the patient, who lies on the CT-table. The robotic arm being calibrated beforehand in the CT reference frame, the target is defined in the intra-operative image and the robotic arm automatically orientates the needle toward it.…”

“…The authors reasonably think that their system should work on man if a respiratory gating technique is used to compensate for breathing motion (that can induce deformations above 3 cm [10]). To our knowledge, only the system in [6] was evaluated in a randomised patient study. Results showed that the robotic arm reduced the insertion duration and the radiation exposure.…”

“…The alternative way is to elaborate a passive evaluation protocol riskless for the patient with a ground truth that is hardly available in standard clinical conditions. Only the robotic system in [6] has been tested on patients to evaluate its benefits in clinical conditions. Unfortunately the accuracy that can be reached in their conditions was not measured.…”

Clinical Evaluation of a Respiratory Gated Guidance System for Liver Punctures

“…CT/IRM guided liver puncture is a difficult gesture which can dramatically benefit from a computer guidance system [3,14,10,5]. Indeed, such systems can reduce the repetitive CT/MRI images needed for needle adjustment and the reinsertion attempts that lengthen the intervention duration and increase radiation exposure (when CT-guided).…”