Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
Updates Surg. 2021 Jun;73(3):1197-1201. doi: 10.1007/s13304-020-00956-7. Epub 2021 Jan 4.
Computed tomography (CT) image-guided procedures including biopsy, drug delivery, and ablation are gaining increasing application in medicine. Robotic technology holds the promise for allowing surgeons, and other proceduralists, access to such CT-guided procedures by potentially shortening training, improving accuracy, decreasing needle passes, and reducing radiation exposure. We evaluated surgeon learning and proficiency for image-guided needle placement with an FDA-cleared robotic arm. Five out of six surgeons had no prior CT-guided procedural experience, while one had prior experience with freehand CT-guided needle placement. All surgeons underwent a 60-min training with the MAXIO robot (Perfint Healthcare, Redmond, WA). The robot was used to place needles into three different pre-specified targets on a spine model. Performance time, procedural errors, and needle placement accuracy were recorded. All participants successfully placed needles into the targets using the robotic arm. The average time for needle placement was 3:44 ± 1:43 min. Time for needle placement decreased with subsequent attempts, with average third placement taking 2:29 ± 1:51 min less than the first attempt. The average vector distance from the target was 2.3 ± 1.2 mm. One error resulted in the need for reimaging by CT scan. No errant needle placement occurred. Surgeons (attending fellows and residents) without previous experience and minimal training could successfully place percutaneous needles under CT guidance quickly, accurately, and reproducibly using a robotic arm. This suggests that robotic technology may be used to facilitate surgeon adoption of CT image-guided needle-based procedures in the future.
计算机断层扫描（CT）图像引导程序，包括活检、药物输送和消融，在医学领域的应用越来越广泛。机器人技术有望通过缩短培训时间、提高准确性、减少针道和降低辐射暴露，使外科医生和其他介入医生能够进行此类 CT 引导的程序。我们评估了经过 FDA 批准的机器人手臂进行图像引导针放置的外科医生学习和熟练程度。六名外科医生中有五名没有 CT 引导程序经验，而一名有徒手 CT 引导针放置经验。所有外科医生都接受了 60 分钟的 MAXIO 机器人（Perfint Healthcare，雷德蒙德，华盛顿州）培训。机器人用于将针插入脊柱模型上的三个不同预定目标。记录操作时间、程序错误和针放置准确性。所有参与者都成功地使用机器人手臂将针插入目标。平均针放置时间为 3:44±1:43 分钟。随着后续尝试次数的增加，放置针的时间减少，第三次尝试的平均时间比第一次尝试少 2:29±1:51 分钟。目标的平均向量距离为 2.3±1.2 毫米。一次错误导致需要进行 CT 扫描重新成像。没有发生错误的针放置。没有经验和最少培训的外科医生（主治医生和住院医生）可以快速、准确和可重复地使用机器人手臂在 CT 引导下成功放置经皮针。这表明机器人技术可能用于促进未来外科医生采用 CT 图像引导的基于针的程序。
