Abstract No. 67 Robot-Assisted CT-Guided Biopsy: An Initial First-in-Human Proof

The purpose of this study was to evaluate the feasibility and safety of a fully robot-assisted needle placement system for CT-guided biopsy in various sites. This study utilized the Automated Needle Targeting device for CT (ANT-C) robotic system (NDR Medical Technology Pte Ltd., Singapore) to provide automated assistance for needle insertion. 11 patients (6 males and 5 females) with a median age of 70 (range 45 to 80 years) underwent robot-assisted percutaneous CT-guided biopsy between January 12, 2023, and August 4, 2023, in our institution. A 320-detector-row CT was used for preoperative scanning and CT fluoroscopy with a reconstruction slice thickness of 0.5 mm and 2.4 mm, respectively. Experienced interventional radiologists (IRs) with more than 10 years of experience performed all procedures. After planning the path on the preoperative CT using custom-made software, the robot moved the needle guide to the intended trajectory for needle insertion. The needle (18-G TEMNO Evolution, MERIT, UT) was inserted using intermittent CT fluoroscopy. After successful needle placement, the needle guide was released from the robot with the inserted needle still in place, and the remaining procedures were performed. The primary criteria for the study were technical success (successful lesion sampling), number of needle adjustments, the number of CT fluoroscopy scans, the duration of the robotic procedure (interval between the first and last use of CT fluoroscopy) and of the entire procedure (interval between initiation of the first CT scan and completion of the final CT scan), and adverse events according to the Clavien-Dindo classification. The target lesions were lungs in 6 cases and pleura, buttocks, paraspinal, kidney, and retroperitoneum in 1 case each. The median maximum diameter was 28 mm (range, 10-103). The number of robot-assisted insertions per lesion ranged from 1 to 4. Fine angle adjustment was required in 6 of the 26 robot-assisted samplings. The median number of CT fluoroscopy scans and median duration of the robotic procedure were 4 (range, 2-13) and 44 seconds (range, 13-896) per sampling, respectively. The mean duration of entire biopsy procedure was 38 minutes (range, 26-63). All specimens were successfully obtained. A total of 5 adverse events occurred in 4 patients, including 4 grade I events and 1 grade IIevent. No adverse events prolonged hospitalization was reported. This initial human study demonstrated the feasibility and safety of the ANT-C system for CT-guided biopsy in different anatomical locations.