Abstract
The “robotic-assisted liver tumor coagulation therapy” (RALTCT) system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1) multiple needles are needed to destroy the entire tumor, (2) the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3) the placement of multiple needles should avoid interference with each other, (4) an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles’ operating environment, and (5) the multiple needle-insertion trajectories should be consistent with the needle-driven robot’s movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle “collision-free reachable workspace” (CFRW), which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor therapy, significantly reduce the surgeon’s workload, and is especially helpful for an inexperienced surgeon. The methodology should be easy to adapt in other body parts.
Highlights
Over the past decade, percutaneous microwave (MW) coagulation therapy, as a minimally invasive surgery, has been used extensively in malignant liver tumor treatments due to its safety, rapid recovery, and low cost
Based on the procedures of the traditional clinical multiple overlapping microwave coagulation (MC) therapy for large liver tumors and the typical operating procedures of the RALTCT system using a single needle for liver or kidney cysts [4], this paper proposes typical operation procedures for the RALTCT system using multiple needles for large liver tumors
We introduced the needle collision-free reachable workspace” (CFRW), in which no interference occurs between the inserted needles and the critical structures
Summary
Percutaneous microwave (MW) coagulation therapy, as a minimally invasive surgery, has been used extensively in malignant liver tumor treatments due to its safety, rapid recovery, and low cost. Only a single needle is required for a small liver tumor microwave coagulation (MC), whereas multiple overlapping MC needs to be applied to cover irregular and large tumors through a series of single-needle MC [1,2,3]. Manual treatment planning and execution is dependent on the surgeon’s experience and it is time-consuming In this regard, the sophisticated robotic-assisted surgery technique is a candidate for the multiple overlapping MC because of its advantages, such as three-dimensional (3D) visualization, needle placement accuracy, and ease of operation. The RALTCT system, developed by our group, has already been used to treat more than 20 patients with liver or kidney cysts This demonstrates the feasibility of our robotic system for precise needle placement [4].
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