Robotic assistance for CT-guided percutaneous needle insertion for treatment of lung and bone tumor

There is a growing interest for robotic assistance in interventional radiology to improve the accuracy, reproducibility, safety of procedures and lower physician exposure to X-ray. This study aims to present off label use in early clinical experience of lung and bone percutaneous therapies with an advanced robotic system recently CE and FDA approved for the abdomen.


Materials and Methods: All consecutive patients treated with Epione robot (Quantum Surgical, Montpellier, France) for lung and bone malignancies were prospectively evaluated. 


Results:

Epione robot (an optically monitored robotic platform allowing needle insertion along preplanned trajectories defined on a 3D volume CT acquisition) was used to treat 15 consecutive patients with 23 targets using 45 needle insertions, including 4 single needle and 11 multiple needle treatments with a mean of 3 needles per patient. Bone was targeted in 10 patients and lung in 6 for thermal ablation (n=6), osteosynthesis/cementoplasty (n=6) or electrochemotherapy (n=3). Procedures were performed under general anesthesia using either conventional ventilation with robotic system respiratory motion compensation (n=10) or jet ventilation (n=5).

Treatments were possible in all instances, with no needle requiring complete reinsertion. All post ablation contrast enhanced CTs show complete ablation or adequate cement or screw position.



Conclusion: After a first in human study previously reported in liver and a routine practice in the abdomen, this first postmark series on lung and bone applications with the Epione robotic system suggests that a robotic-guided needle insertion is safe, highly feasible, and provided efficient thermal ablation of lung tumors and bone reconstruction.