Robot-assisted radiofrequency ablation of primary and secondary liver tumours: early experience

Basri Johan Jeet Abdullah, Chai Hong Yeong, Khean Lee Goh, Boon Koon Yoong, Gwo Fuang Ho, Carolyn Chue Wai Yim, Anjali Kulkarni, Basri Johan Jeet Abdullah, Chai Hong Yeong, Khean Lee Goh, Boon Koon Yoong, Gwo Fuang Ho, Carolyn Chue Wai Yim, Anjali Kulkarni

Abstract

Objective: Computed tomography (CT)-compatible robots, both commercial and research-based, have been developed with the intention of increasing the accuracy of needle placement and potentially improving the outcomes of therapies in addition to reducing clinical staff and patient exposure to radiation during CT fluoroscopy. In the case of highly inaccessible lesions that require multiple plane angulations, robotically assisted needles may improve biopsy access and targeted drug delivery therapy by avoidance of the straight line path of normal linear needles.

Methods: We report our preliminary experience of performing radiofrequency ablation of the liver using a robotic-assisted CT guidance system on 11 patients (17 lesions).

Results/conclusion: Robotic-assisted planning and needle placement appears to have high accuracy, is technically easier than the non-robotic-assisted procedure, and involves a significantly lower radiation dose to both patient and support staff.

Key points: • An early experience of robotic-assisted radiofrequency ablation is reported • Robotic-assisted RFA improves accuracy of hepatic lesion targeting • Robotic-assisted RFA makes the procedure technically easier with significant lower radiation dose.

Figures

Fig. 1
Fig. 1
a Contrast-enhanced baseline CT image shows solitary colorectal metastases (26.2 mm diameter) in segment VI. b Reconstructed CT images (slice thickness 1 mm) were sent to the ROBIO™ EX workstation for treatment planning. The simulated needle trajectory path was shown on the treatment plan and verified by the radiologist. c A CT fluoroscopy check was carried out to verify the accuracy of the needle placement within the target volume. d Post-RFA three-phase CTs to assess the completeness of tumour ablation
Fig. 2
Fig. 2
The robotic arm was positioned automatically to the exact coordinates according to the treatment plan. The bush and bush holder were clamped firmly at the end-effector of the robotic arm before insertion of the RFA needle through the bush
Fig. 3
Fig. 3
The RFA needle was inserted by the radiologist through the bush and the bush holder. The needle was then pushed to the predetermined depth where the end-effector of the robotic arm was located. The robotic arm was then detached from the RFA needle to allow a CT check of positioning

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Source: PubMed

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