Automatic planning of needle placement for robot-assisted percutaneous procedures

A 28 year-old obese woman was scheduled for robot-assisted bilateral tubal re-anastomosis under general anesthesia and neuromuscular blockade. As part of a respiratory mechanics study, gastric pressure (Pga) was measured. At the beginning of the operation, the surgeon repeatedly inserted a Veress needle consistently measuring an unusually high opening pressure of 15 mmHg, at a time when Pga was 12.5 mmHg. Based on the elevated Pga values, we inferred that the high opening pressure was a valid intra-peritoneal pressure, rather than a sign of incorrect needle placement; therefore, the surgeon proceeded with uneventful insufflation of the peritoneal cavity. This patient exhibited an unusually high opening intra-abdominal pressure that likely reflected her high degree of central obesity. Simultaneous Pga determination proved valuable in confirming intra-peritoneal location of the tip of Veress needle and may be a viable method of corroborating high opening pressures despite safe needle positions in laparoscopic cases.

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A targeting method for robot-assisted percutaneous needle placement under fluoroscopy guidance

Computer Assisted Surgery ◽

10.1080/24699322.2018.1560085 ◽

2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Zhonghao Han ◽

Keyi Yu ◽

Lei Hu ◽

Weishi Li ◽

Huilin Yang ◽

...

Keyword(s):

Needle Placement ◽

Robot Assisted ◽

Fluoroscopy Guidance

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A targeting method for robot-assisted percutaneous needle placement under fluoroscopy guidance

Computer Assisted Surgery ◽

10.1080/24699322.2018.1557907 ◽

2019 ◽

Vol 24 (sup1) ◽

pp. 44-52 ◽

Cited By ~ 2

Author(s):

Zhonghao Han ◽

Keyi Yu ◽

Lei Hu ◽

Weishi Li ◽

Huilin Yang ◽

...

Keyword(s):

Needle Placement ◽

Robot Assisted ◽

Fluoroscopy Guidance

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Towards a companion system for collision avoidance during robot-assisted needle placement

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2021-1027 ◽

2021 ◽

Vol 7 (1) ◽

pp. 126-129

Author(s):

Eva Currle ◽

Johannes Hemm ◽

Armin Schäfer ◽

Philipp Beckerle ◽

Johannes Horsch ◽

...

Keyword(s):

Augmented Reality ◽

Collision Avoidance ◽

Preoperative Planning ◽

Complication Rates ◽

Robotic Assistance ◽

Needle Placement ◽

Robot Assisted ◽

Augmented Reality Application ◽

Improve Accuracy ◽

Assistance Systems

Abstract Robotic assistance systems for surgery enable fast and precise interventions with reduced complication rates. However, these benefits are accompanied by a more complex operating room (OR) and the risk of collision with robotic assistance systems. Current strategies for collision avoidance and minimizing possible injuries require the adaptation of robotic trajectories and a computational model of the surroundings. In contrast, this work presents a novel companion system for collision avoidance without influencing robotic trajectories. The companion system consists of a preoperative planning application and an augmented reality application for intraoperative support. The companion system visualizes the workflow within the OR and allows robot movements to be seen virtually, before they are executed by the actual robotic assistance system. Preliminary experiments with users imply that the companion system leads to a positive user experience, enables users to follow a predefined workflow in the OR, but requires further refinement to improve accuracy for practical collision avoidance.

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Compact 3D-Printed Active Flexible Needle for Percutaneous Procedures

Surgical Innovation ◽

10.1177/1553350620945564 ◽

2020 ◽

pp. 155335062094556

Author(s):

Zahra K. Varnamkhasti ◽

Bardia Konh

Keyword(s):

Medical Imaging ◽

Clinical Outcomes ◽

Control Unit ◽

Prostate Brachytherapy ◽

Needle Placement ◽

Percutaneous Procedures ◽

Tissue Phantom ◽

Tumor Visualization ◽

Angular Deflection ◽

3D Printed

Needle-based intervention has been a popular procedure for diagnosis and treatment of many types of cancer. However, poor needle placement and tumor visualization have been among the challenges resulting in poor clinical outcomes. There has been a lot of progress in medical imaging technology, but the structure of surgical needles has remained unchanged. This work presents a wire-driven 3D steerable, 3D-printed active needle for improved guidance inside the tissue toward the target. The needle is manipulated by 3 embedded tendons via a programmed motorized control unit. Feasibility tests in a tissue phantom showed an average 3D needle angular deflection of about 11°. This amount of angular deflection is expected to assist prostate brachytherapy via a curvilinear approach.

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Percutaneous Lymphatic Maceration and Glue Embolization for High-output Chylous Ascites after Robot-assisted Laparoscopic Nephrectomy and Lymphadenectomy

Journal of Clinical Imaging Science ◽

10.25259/jcis_100_2021 ◽

2021 ◽

Vol 11 ◽

pp. 56

Author(s):

Paige Ashley Hargis ◽

Brandon Henslee ◽

Pokala Naveen ◽

Ambarish Bhat

Keyword(s):

Renal Cell Carcinoma ◽

Lymph Node ◽

Minimally Invasive ◽

Radical Nephrectomy ◽

Chylous Ascites ◽

Node Dissection ◽

Robot Assisted ◽

Percutaneous Procedures ◽

Glue Embolization ◽

High Output

To propose minimally invasive percutaneous techniques in the management of high output chylous ascites, a known potential complication of retroperitoneal surgery associated with significant morbidity and mortality. Management has traditionally been based on successful treatment reported in the literature. However, refractory or high-output leaks often prove difficult to treat and there is little evidence on superior management. We report percutaneous maceration and embolization for the management of high-volume abdominal chyle leak after robot-assisted laparoscopic (RAL) radical nephrectomy and lymph node dissection for renal cell carcinoma. A 68-year-old male with incidentally found renal cell carcinoma underwent RAL radical nephrectomy with paraaortic lymph node dissection. He initially improved after surgery but developed significant abdominal pain and distension approximately 7 weeks postoperative. This proved to be chyloperitoneum. Conservative management was initiated, but after continued high-output (>1 L) fluid drainage, we pursued adjunct intervention involving Interventional Radiological percutaneous procedures. This included lymphatic maceration and glue embolization of leaking lymphatics. The patient tolerated the percutaneous procedures well with significant improvement in drain output ultimately leading to complete resolution of ascites without further complication. Similar interventions have previously been reported in the literature for cases of chylothorax with success. However, there is a lack of reports on utilizing this minimally invasive procedure for chyloperitoneum after retroperitoneal urologic surgery. We report our successful experience with percutaneous lymphatic maceration and embolization for high output chylous ascites after RAL radical nephrectomy with lymphadenectomy. We believe that early initiation utilizing these percutaneous techniques can achieve timely resolution and should be considered in the management of these patients.

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