Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap

Abstract

Interventional oncology (IO) is the field of Interventional Radiology that provides minimally invasive procedures under imaging guidance for the diagnosis and treatment of malignant tumors. Sophisticated devices can be utilized to increase standardization, accuracy, outcomes, and "repeatability" in performing percutaneous Interventional Oncology techniques. These technologies can reduce variability, reduce human error, and outperform human hand-to-eye coordination and spatial relations, thus potentially normalizing an otherwise broad diversity of IO techniques, impacting simulation, training, navigation, outcomes, and performance, as well as verification of desired minimum ablation margin or other measures of successful procedures. Stereotactic navigation and robotic systems may yield specific advantages, such as the potential to reduce procedure duration and ionizing radiation exposure during the procedure and, at the same time, increase accuracy. Enhanced accuracy, in turn, is linked to improved outcomes in many clinical scenarios. The present review focuses on the current role of percutaneous navigation systems and robotics in diagnostic and therapeutic Interventional Oncology procedures. The currently available alternatives are presented, including their potential impact on clinical practice as reflected in the peer-reviewed medical literature. A review of such data may inform wiser investment of time and resources toward the most impactful IR/IO applications of robotics and navigation to both standardize and address unmet clinical needs.

Keywords: ablation; biopsy; navigation; robotics.

Figure 1

A 58-year-old male patient with a mass in the left adrenal gland. Biopsy was performed using an electromagnetic navigation device.

Figure 2

Case of a stereotactic radiofrequency ablation (SRFA) in an 85-year-old male with a sub-cardiac HCC (4.8 cm): (A) Arterial phase planning CT; (B) Portal-venous phase planning CT; (C) MIP of the control CT, showing in total 7 inserted coaxial needles; (D) Screenshot of the frameless stereotactic navigation system: Superposition of the needle control CT on the planning CT, with the pathways showing precise placement of all needles; (E) Contrast-enhanced control CT (portalvenous phase), showing the large ablation zone covering the HCC, including a sufficient safety margin, which was confirmed by image fusion.

Figure 3

An 82-year-old female RCC patient with multiple metastatic lesions was treated with percutaneous cryoablation of a soft tissue mass in the posterior paravertebral muscles for pain palliation. (A) The ablation procedure was performed under CT guidance using a robotic navigation device. (B) Four cryoprobes were placed under CT guidance using the robotic navigation device. (C) Axial CT scan during ablation illustrating the ice ball and a sterile glove filled with warm water placed on the skin for protection.

Figure 4

A 73-year-old male HCC patient was treated with percutaneous radiofrequency ablation in segment VIII. The ablation procedure was performed under CT guidance using an AR navigation device. (A) The small HCC (red circle) is visible in arterial phase. (B) AR guidance from the physician’s point of view. The liver is in red; the bones of thoracic case are in white; the liver vessels are in light-blue, and the lesion is in green. The green line shows the trajectory that connects the tip of the needle to the center of the target in real time. (C) Axial CT scan showing the tip of the needle (red circle) precisely located in the center of the lesion after the guidance by AR.