Robotic assisted IR procedures: Early experience and advice to ease the learning curve

Monday, March 6, 2023

5:45 PM – 5:50 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Peter J. Park, MD

Assistant Professor
Emory University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

KA

Kamil Arif, MD

Assistant Professor, Dept of Radiology
Emory University School of Medicine
BS

Bryan Swilley, MD

Assistant Professor
Emory University
JG

Judy Gichowa, MD, MS

Assistant Professor
Emory University School of Medicine
Janice Newsome, MD, FSIR

Associate Professor
Emory School of Medicine
Zachary L. Bercu, MD RPVI (he/him/his)

Assistant Division Director, Innovation and Strategy; Associate Professor
Emory University School of Medicine

Disclosure(s):

Peter J. Park, MD: No financial relationships to disclose

Kamil Arif, MD: No financial relationships to disclose

Janice Newsome, MD, FSIR: Boston Scientific: Advisory Committee or Review Panel Member (Ongoing); CARESTREAM: Research Grant Recipient (Ongoing); Cook Inc: Consultant (Ongoing); Medtronic: Research Grant Recipient (Ongoing); TVIR: Co Editor (Ongoing)

Zachary L. Bercu, MD RPVI: Terumo Medical Corporation: Speaking and Teaching (Ongoing); XAct Robotics: Advisory Committee or Review Panel Member (Ongoing)

Learning Objectives: -Patient preparation and robotic case set-up
-Robotic procedural limitations and patient selection
-Practical tips and troubleshooting of commonly encountered problems during robotic cases

Background: Robotic assisted procedures are commonly performed across specialties and have been shown to improve procedural outcomes, increase technical control, and decrease radiation exposure. Our institution has recently started using robotic assistance for CT guided procedures, with initial usage limited to biopsies. We hope to share our early experience as well as lessons learned along the way. We will describe patient selection, set up, limitations, practical tips, and how to troubleshoot commonly encountered problems.

Clinical Findings/Procedure Details: Initial patient preparation is similar to non-robotic CT cases. After an initial localization scan, the robotic docking station is then placed over the skin entry site and a registration scan is performed. The robotic workstation is then used to select the skin entry and target sites with resultant trajectory and multiplanar reconstructions displayed on the monitor. The biopsy device assembly is then connected to the robot and the needle is advanced to pre-selected checkpoints. A limited scan is performed at each checkpoint and if trajectory deviation is noted, non-linear steering can be used to redirect the needle between each checkpoint. However, it must be noted that the needle cannot be retracted and if there is excessive deviation from the trajectory, conversion to a non-robotic approach may be required. When the target is reached, the robot can either be left in place or undocked and biopsy samples are obtained in standard fashion. Overall, we find the robotic system beneficial for cases with challenging anatomic locations, target depth, and mobile targets (particularly lung lesions).

Conclusion and/or Teaching Points: Robotic-assistance is employed for a variety of procedures across specialties. Our early experience demonstrates improved technical control for difficult cases due to anatomy, target mobility, or target depth. We hope that our experience helps others overcome the associated learning curve and add robotic-guidance to the interventional radiologists’ armamentarium.