Robotic Needle Driver Research Articles

Optimisation of path planning for minimally invasive interventions on prostate using MR-robot: Application to on-live pets

The robot-assisted biopsy system under Magnetic Resonance Imaging (MRI) guidance is a promising candidate for prostate cancer diagnosis in terms of improving the reliability and accuracy of reaching micro-lesions of perineum organ tissues. This has been explored for the last decade. A pre-requisite for effective interventional diagnosis is an accurate intervention planning that is difficult to achieve manually. This is due to multiple factors mainly, the fact that the insertion needles trajectories should avoid organs at risk and limited manoeuvrability, under clinician control. Thus, Biopsy-robot is a feasible solution to improve targeting accuracy. However, the planned trajectories should be consistent with the needle-driven robot's kinematics capabilities. To eliminate these problems, we present an integrated concept composed of MRI-robot and Brachytherapy (BT) path planning algorithm, allowing to minimise the number of entry points of BT needles, from a physical grid to reach all the treatable volume of the prostate gland. This means minimising the number of inserted needles from the perineum, compared to a conventional straight insertion of multiple needles. Indeed, the proposed method is able to set-up safe percutaneous routes defined by a set of oblique straight-line paths linking a minimum number of feasible entry points and desired finite target points, defined within the prostate volume. By adopting such a procedure, the aim is to contribute in minimising tissue damage and patient trauma, and risk of infection, and shortening recovery time. A combinatorial approach is proposed for the minimisation of the insertion point. The development, implementation, and experimental evaluation of the needle path planning method for the 5 Degree of Freedom (DoF) robot guide is presented and performed within a 1.5 Tesla MRI to evaluate how the proposed approach is efficient and reliable on-live pets.

Artificial Intelligence and Robotics in Regional Anaesthesia: Do they have a role?

Artificial Intelligence and Robotics in Regional Anaesthesia: Do they have a role?

Sewing up the Wounds: A Robotic Suturing System for Flexible Endoscopy

If a perforation occurs as a result of a flexible endoscopic procedure, urgent laparoscopy or open surgery may be required to repair the perforation, because suturing is normally stronger than closure using existing endo-scopic devices. Suturing with stitches and knots, widely adopted in open or laparoscopic surgery, is still not possible in flexible endoscopy. This is due to the confined space of the natural orifice and target area, the high levels of motion dexterity and force needed for stitching and knot tying, and the critical size and strength requirements of wound closure. We present a novel flexible endoscopic robotic suturing system that can suture gastrointestinal defects without opening up the patient's body as in open or laparo scopic surgery. This system features a robotic needle driver and a robotic grasper, both of which are flexible, small enough for through-the-scope delivery, and dexterous with five degrees of freedom (DoF). The needle driver, facilitated by the grasper, enables the surgeon to control a needle through teleoperation and so make stitches and knots in flexible endoscopy. Successful in vivo trials were conducted in the rectum of a live pig to confirm the feasibility of endoscopic suturing and knot tying using the system in a realistic surgical scenario (not possible with existing devices, which are all manually driven) . This new technology will change the way surgeons close gastro intestinal defects.

Enhancing haptic feedback of subsurfaces during needle insertion

Abstract Haptic feedback can be helpful for accurate needle insertion but is complicated by friction on the needle shaft. Concepts to directly measure the forces at the needle tip exist but cause additional cost and complexity. Moreover, haptic devices may show inaccuracies in recreating forces. We present a novel force feedback method that uses needle shaft forces and enhances haptic feedback of subsurfaces based on robotic ultrasound elastography. This approach allows to overcome accuracy limitations of haptic devices. We evaluate our method in a volunteer subject study using recordings from a robotic needle driver setup. We compare haptic feedback based on shaft and enhanced force for the detection of surfaces inside of gelatin phantoms. Using our method, the error of subsurface detection decreased from more than 16 to about 1.7 mm for the first subsurface. A second subsurface was solely detectable using our method with an error of only 1.4 mm. Insertion time decreased by more than 32%. The results indicate that our enhanced sensor is suitable to detect subsurfaces for untrained subjects using a haptic feedback device of limited accuracy.

Developing a Compact Robotic Needle Driver for MRI-Guided Breast Biopsy in Tight Environments

In this letter, we present the design and development of a new robotic system for MRI-guided breast biopsy. The robot's structure is nonmagnetic, therefore, it can safely operate from within the scanner's magnetic bore; it has a compact Cartesian mechanism that allows it perform needle insertion tasks from both frontal and lateral directions inside an open bore scanner. A combination of piezoelectric and pneumatic actuators drive the motion of the proposed three degrees-of-freedom robot. To control the needle's insertion, we present an adaptive position regulator that uses the feedback from multiple sensors and that is robust to external disturbances. A detailed experimental study is presented to validate the performance and magnetic properties of the new mechanical prototype.

A robotic needle driver to facilitate vescico-urethral anastomosis during laparoscopic radical prostatectomy.

The completion of the vescico-urethral anastomosis (VUA) represents the most critical step of laparoscopic radical prostatectomy (LRP), and it can often discourage the use of minimally invasive surgery in less experienced laparoscopic surgeons. The aim of this paper is to evaluate the usefulness of a new robotic needle driver named Dextérité in performing the VUA after LRP. This prospective randomized clinical study enrolled 40 consecutive patients eligible for LRP, which were randomized into four groups: group A, patients undergoing LRP done by an expert surgeon; group B, patients undergoing robotic-assisted radical prostatectomy (RARP) performed by the same expert surgeon; group C, patients undergoing LRP performed by a young surgeon at the beginning of the learning curve; group D, patients undergoing LRP performed by another young surgeon at the beginning of the learning curve with the aid of Dextérité needle driver for completion of the VUA. The two young urologists performed the same steps of LRP so that they are at the same step of the learning curve. All the anastomosis were performed with the same technique in order to be comparable. We use interrupted sutures with Vicryl 2/0 and a 5/8 needle; we performed the Rocco stitch technique before all the anastomosis (6) and we applied bladder neck sparing technique. All patients underwent an ultrasound control of the anastomosis on the seventh postoperative day, as we usually do (9, 10). We consider continent who utilised no pad. Operative VUA completion time was 24.9 vs. 25 vs. 86.7 vs. 61 minutes, respectively. When comparing VUA completion time in group 3 and 4, the use of the Dextérité needle driver resulted in a reduction in VUA time. Urinary leakage was seen in zero out of 10 patients in groups 1 and 2 and in three out of 10 and one in 10 patients, respectively, in groups 3 and 4. All urinary leakages were managed conservatively. One-year continence rates were 95%, 97%, 93% and 95%, respectively. Only one patient in group C developed a bladder neck contracture 6 months after the procedure, but he underwent adiuvant radiotherapy after surgery. Our data suggest that the use of Dextérité needle holder significantly reduces operative time of VUA completion and reduces the incidence of urinary leakage in laparoscopic surgeons at the beginning of the learning curve.

Reducing Costs for Robotic Radical Prostatectomy: Three-instrument Technique

To describe our technique for performing robotic-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection using only 3 robotic instruments to reduce disposable costs associated with the robotic surgical platform. The financial impact of robotic surgery is real. Whereas the initial capital investment of the robotic platform (including the cost of the device itself and the maintenance contract) is largely fixed, the cost of disposable instrumentation can vary depending on utilization. Herein we describe our technique for 3-instrument robotic radical prostatectomy that may decrease costs by limiting the use of disposable instruments. Exclusion of the high-cost energy instruments may reduce operative costs by up to 40%. In addition, using 1 robotic needle driver vs 2 may decrease overall costs by another 12%. At our institution, we have adopted these techniques in cost-efficiency and have gone further by only using 3 instruments during robotic radical prostatectomy. The only 3 instruments necessary to perform a successful RALP are a robotic needle driver, Prograsp forceps, and monopolar scissors. To improve the value of care while utilizing robotic technology, we must be cognizant of keeping operative costs to a minimum while maintaining positive patient outcomes. We demonstrate here a method to decrease disposable operating room costs while preserving the ability to successfully perform a RALP.

Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy.

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.

V7-06 RECIPIENT ROBOT ASSISTED KIDNEY TRANSPLANT LEARNING STEPS: FRAME-BY-FRAME VIDEO ANALYSIS

You have accessJournal of UrologyTrauma/Robotics1 Apr 2014V7-06 RECIPIENT ROBOT ASSISTED KIDNEY TRANSPLANT LEARNING STEPS: FRAME-BY-FRAME VIDEO ANALYSIS Mahendra Bhandari, Deepansh Dalela, Akshay Sood, Rajesh Ahlawat, Pranjal Modi, Ronney Abaza, Mani Menon, Khurshid Ghani, and Wooju Jeong Mahendra BhandariMahendra Bhandari More articles by this author , Deepansh DalelaDeepansh Dalela More articles by this author , Akshay SoodAkshay Sood More articles by this author , Rajesh AhlawatRajesh Ahlawat More articles by this author , Pranjal ModiPranjal Modi More articles by this author , Ronney AbazaRonney Abaza More articles by this author , Mani MenonMani Menon More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , and Wooju JeongWooju Jeong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2036AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transplant surgeons learning robot-assisted kidney transplant (RAKT) should master skills specific to robotic vascular anastomoses in the dry and wet laboratory before proctoring on a patient. We compared the video recordings of the vascular anastomoses done by two groups of RAKT-performing transplant surgeons: one with extensive robotic experience, and other with minimal robotic orientation. We aimed to identify specific domains that require training to ensure safe and efficient performance of RAKT. METHODS 41 patients undergoing recipient RAKT were classified into two groups based on the transplant surgeon’s robotic experience: Group 1 (n=27) with extensive robotic experience (>2000 cases), and Group 2 (n=14) with minimal robotic orientation (<10 cases). Surgeons in both groups had extensive open kidney transplant experience (>2000 cases for each). Measures of surgical process and functional patient outcomes were recorded for all 41 patients. Experienced robotic and transplant surgeons proctored all the operations to minimize compromise in functional patient outcomes. Two independent reviewers retrospectively analyzed the video recordings of venous and arterial anastomoses of 6 cases from each group (3 initial cases and 3 final cases in each group). RESULTS The results are summarized in Tables 1 and 2. There was no significant difference in the baseline characteristics of patients in both the groups. Console camera modulation to optimize magnification of the operating field, tissue handling in absence of tactile feedback, and coordination of the robotic needle driver and forceps with the needle and suture were recognized as vital training points for vascular anastomoses. CONCLUSIONS We found that even experienced open kidney transplant surgeons need extensive training for robotic surgery. The differences in vascular anastomoses techniques of transplant surgeons with vs. without robotic experience, as shown in the video, can be used to mentor trainee surgeons in the laboratory before patient proctoring, thereby ensuring patient safety. Table 1. Measures of surgical process and perioperative outcomes for extensive robotic vs minimal robotic orientation group. Group 1 Group 2 p-value Measures of surgical process Operative time: Incision-closure (min), mean (SD) [range] 211.8 (40.7) [156-293] 305.7 (38.8) [250-385] <0.001 Re-warming time (with Ice-slush) (min), mean (SD) [range] 45.9 (9.4) [27-66] 70.8 (15.3) [48-92] <0.001 Vascular anastomoses times Arterial anastomosis (min), mean (SD) [range] 11.7 (2.5) [7-16] 22.6 (7.9) [14-46] <0.001 Venous anastomosis (min), mean (SD) [range] 13.3 (3.7) [8-21] 18.4 (6.4) [11-30] 0.01 Uretero-vesical anastomosis time (min), mean (SD) [range] 15.7 (4.3) [11-27] 42.2 (11.3) [23-65] <0.001 Functional patient outcomes Serum creatinine POD 7 (mg/dl), mean (SD) [range] 1.4 (0.6) [0.7-3.1] 1.5 (1.0) [0.7-4.8] 0.63 Estimated glomerular filtration rate POD 7 (ml/min)ˆ , mean (SD) [range] 70.3 (32.1) [24.5-150.4] 61.9 (29.0) [12.3-127.6] 0.69 ˆ Using Modified Diet in Renal Disease (MDRD) equation for > 18 years old and Schwartz equation for < 18 years old; POD = Post-operative day Table 2. Multivariable linear regression analysis: extensive robotic vs minimal robotic surgery experience as predictor of perioperative outcomes Correlation-coefficient (CI) p-value Measures of surgical process Re-warming time (with Ice-slush) -28.5 (-40.7 to -16.4) <0.001 Vascular anastomoses times Arterial anastomosis -5.1 (-8.6 to -1.5) 0.006 Venous anastomosis -10.9 (-14.8 to -7.1) <0.001 Uretero-vesical anastomosis -26.5 (-32.1 to -20.8) <0.001 Functional patient outcomes Serum creatinine POD 7 -0.3 (-1.1 to 0.5) 0.78 Estimated glomerular filtration rateˆ 8.4 (-13.5 to 30.3) 0.44 ˆ Using Modified Diet in Renal Disease (MDRD) equation for > 18 years old and Schwartz equation for < 18 years old; POD = Post-operative day © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e736-e737 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mahendra Bhandari More articles by this author Deepansh Dalela More articles by this author Akshay Sood More articles by this author Rajesh Ahlawat More articles by this author Pranjal Modi More articles by this author Ronney Abaza More articles by this author Mani Menon More articles by this author Khurshid Ghani More articles by this author Wooju Jeong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Comparison of Cellular Damage Using Electrocautery and CO2 Laser in Transoral Robotic Glossectomy

Objectives:1) Compare the zone of cellular damage using monopolar electrocautery and CO2 laser during transoral robotic glossectomy. 2) Examine the effect of tissue tension during glossectomy on the extent of cellular damage. 3) Highlight the choice of energy source during transoral robotic glossectomy with margin assessment.Methods:Setting: Memorial Hermann Robotics Institute, November 2012.. A live anesthetized porcine model placed supine with the ventral tongue exposed. Multiple robotic glossectomies were performed using monopolar cautery (15 watts delivered via a robotic arm) and CO2 laser (8 watts delivered via FlexGuide Fiber Introducer carried by a Robotic needle driver). The study was then repeated with 4 lbs of weighted tension on each side of the tongue to simulate the concept of tension‐countertension. Glossectomy specimens were harvested and evaluated in a blinded manner by a pathologist for the zone of cellular damage.Results:Unpaired t‐test with unequal variance was conducted to compare the zone of cellular damage (mm) from the electrocautery and the CO2 laser glossectomy. There was a significant difference in the damage zone for EC and CO2; two‐tailed P less than 0.0001; t(27) = 7.08; Standard Error of Difference = 0.062.Conclusions:The zone of cellular damage from the edge of the incision is significantly greater with electrocautery than CO2 laser in this robotic porcine glossectomy model. The difference is further amplified when tension‐countertension is applied to the tissues. These data suggest that robotic CO2 laser glossectomy may preserve more normal tissue (margins) around a specimen than electrocautery.

Effect of Robotic Manipulation on Unidirectional Barbed Suture Integrity: Evaluation of Tensile Strength and Sliding Force

One of the more challenging portions of robot-assisted radical prostatectomy (RARP) is the urethrovesical anastomosis. Because of this, a unidirectional absorbable barbed suture (V-Loc(™)) has been used to complete the anastomosis with better efficiency and less tension. The effect of robotic needle driver manipulation on barbed suture is unknown. Therefore, the aim of this study is to determine whether robotic manipulation decreases the tensile strength and peak sliding force of V-Loc barbed suture. Fifty-six V-Loc sutures were compared with 56 Maxon sutures. All sutures were 3-0 caliber. Half of the sutures in each group were manipulated with a da Vinci(®) robot large needle driver five times over a 5 cm length of suture. The other half was not manipulated. Breaking force was determined by placing sutures in a Bose ElectroForce load testing device. For sliding force testing, 28 V-Loc sutures were manipulated in the same fashion and compared with 28 nonmanipulated V-Loc sutures. Peak force needed to make the suture slip backward in porcine small intestine was determined to be the sliding force. Scanning electron microscopy of the barbs before and after robotic manipulation was also performed. The mean difference in breaking forces for manipulated vs nonmanipulated Maxon sutures was 4.52 N (P=0.004). The mean difference in breaking forces for manipulated vs nonmanipulated V-Loc sutures was 1.30 N (P=0.046). The manipulated V-Loc group demonstrated a lower peak sliding force compared with the nonmanipulated group (0.76 vs 0.88 N, P=0.199). Electron microscopy revealed minor structural damage to the barbs and suture. Tensile strength and peak sliding force of V-Loc suture is decreased by robotic manipulation. This is likely because of structural damage to the suture and barbs. This structural damage, however, is likely not clinically significant.

Design of the needle-driven robot for radio frequency ablation therapy based on ultrasound navigation

The ultrasonic image guided radio frequency ablation surgery is an effective technique in liver tumour treatment. However, the traditional surgery imposes a constraint for surgeons to have high precision in their hand?eye coordination. This paper discusses the design of an assisted medical robot system to reduce these requirements; the needle-driven robot system consists of needle-driven robot, 3D model navigation and a magnetic tracker. In the pre-operative phase, 3D model of the liver tumour is reconstructed and the needle insertion path is planed. In the intra-operative phase, the surgeon matches the pre-operative 3D model of the liver with real patient?s liver. Then, the needle-driven robot moves accurately at the target point where the surgeon inserts the needle into the liver tumour to destroy the tumour with microwave coagulation. A small and compact medical robot is proposed based on workspace optimisation in this paper. Experimental results show that the needle-driven robot location errors are less than 0.2 mm, whereas the robot ultrasound navigation system errors are less than 2.5 mm.

Diminished Suture Strength After Robotic Needle Driver Manipulation

Robot-assisted minimally invasive surgery has become a routine surgical option for the treatment of prostate cancer. Despite its technical advancements, the da Vinci(®) Surgical System still lacks haptic feedback to the surgeon, resulting in a maximally applied compressive force by the robotic needle driver during every grasping maneuver. Without this perceptional sense of touch and grip control, repetitive robotic needle driver manipulation may unknowingly lead to irreparable damage to fine sutures used during delicate anastomotic repairs. For robotic prostatectomy, any such loss of integrity can potentially lead to premature breakdown of the urethrovesical anastomosis and urine extravasation, especially important for a less-than-perfectly fashioned anastomotic repair. Although it has already been established that overhandling of sutures using handheld laparoscopic instruments can lead to reduced suture strength, it has not been established to what extent this may occur after robotic surgical procedures. We present analytical data and analyses concerning the failure strength of fine sutures commonly used for urethrovesical anastomotic repair during robotic prostatectomy, after repetitive robotic needle driver manipulation. When compared with noncompromised monofilament suture controls, the average maximal failure force after repetitive robotic manipulation was significantly reduced by 35% (p < 0.0001). Similarly, the average maximal failure force of braided sutures was significantly reduced after repetitive robotic manipulation by 3% (p = 0.009). This work demonstrates that significant reductions in monofilament and braided suture strength integrity can occur after customary repetitive manipulation by robotic needle drivers in an ex vivo model, with further research warranted in the in vivo setting.

Three‐dimensional ultrasound image‐guided robotic system for accurate microwave coagulation of malignant liver tumours

The further application of conventional ultrasound (US) image-guided microwave (MW) ablation of liver cancer is often limited by two-dimensional (2D) imaging, inaccurate needle placement and the resulting skill requirement. The three-dimensional (3D) image-guided robotic-assisted system provides an appealing alternative option, enabling the physician to perform consistent, accurate therapy with improved treatment effectiveness. Our robotic system is constructed by integrating an imaging module, a needle-driven robot, a MW thermal field simulation module, and surgical navigation software in a practical and user-friendly manner. The robot executes precise needle placement based on the 3D model reconstructed from freehand-tracked 2D B-scans. A qualitative slice guidance method for fine registration is introduced to reduce the placement error caused by target motion. By incorporating the 3D MW specific absorption rate (SAR) model into the heat transfer equation, the MW thermal field simulation module determines the MW power level and the coagulation time for improved ablation therapy. Two types of wrists are developed for the robot: a 'remote centre of motion' (RCM) wrist and a non-RCM wrist, which is preferred in real applications. The needle placement accuracies were < 3 mm for both wrists in the mechanical phantom experiment. The target accuracy for the robot with the RCM wrist was improved to 1.6 +/- 1.0 mm when real-time 2D US feedback was used in the artificial-tissue phantom experiment. By using the slice guidance method, the robot with the non-RCM wrist achieved accuracy of 1.8 +/- 0.9 mm in the ex vivo experiment; even target motion was introduced. In the thermal field experiment, a 5.6% relative mean error was observed between the experimental coagulated neurosis volume and the simulation result. The proposed robotic system holds promise to enhance the clinical performance of percutaneous MW ablation of malignant liver tumours.

Robotically assisted lung biopsy under CT fluoroscopy: Lung cancer screening and phantom study

Lung cancer is an important clinical problem and lung cancer screening may lead to an early diagnosis. CT fluoroscopy-guided lung biopsy is a popular method for obtaining a tissue sample for lung cancer diagnosis. However, the radiation exposure for the physician associated with CT fluoroscopy may limit more widespread adoption of this technique. The use of a robotic needle driver that can hold the needle in a steady and precise manner on the CT fluoroscopy scan plane may provide accurate needle placement without exposing the physician to radiation. This paper will provide background on lung cancer screening, review the CT fluoroscopy-guided lung biopsy procedure, and present the results of the first phantom study to use a robotic needle driver. An interventional radiologist used a robotic needle driver under joystick control to accurately place needles into a simulated lesion in a respiratory motion phantom under CT fluoroscopy guidance.

Precision placement of instruments for minimally invasive procedures using a “needle driver” robot

Medical practice continues to move toward less invasive procedures. Many of these procedures require the precision placement of a needle in the anatomy. Over the past several years, our research team has been investigating the use of a robotic needle driver to assist the physician in this task. This paper summarizes our work in this area. The robotic system is briefly described, followed by a description of a clinical trial in spinal nerve blockade. The robot was used under joystick control to place a 22 gauge needle in the spines of 10 patients using fluoroscopic imaging. The results were equivalent to the current manual procedure. We next describe our follow-up clinical application in lung biopsy for lung cancer screening under CT fluoroscopy. The system concept is discussed and the results of a phantom study are presented. A start-up company named ImageGuide has recently been formed to commercialize the robot. Their revised robot design is presented, along with plans to install a ceiling-mounted version of the robot in the CT fluoroscopy suite at Georgetown University.

Robotically Assisted Nerve and Facet Blocks: A Cadaveric Study

Rationale and Objectives This study was performed to evaluate the feasibility of using a joystick-controlled robotic needle driver to place a 22-gauge needle for nerve and facet blocks. Materials and Methods Biplane fluoroscopy and a robotic needle driver were used to place 12 needles into the lumbar paraspinal region of an embalmed female cadaver (age at death, 98 years). Small metal BB nipple markers (1 mm in diameter) were inserted percutaneously to serve as targets. Six needles were then placed near the nerve root, and six were placed near the facet root. Anteroposterior and lateral radiographs were obtained after each needle placement to assess its accuracy. Results All needles were placed within 3 mm of the target BB. The average distance was 1.44 mm ± 0.66 (standard deviation). Discussion A robotic needle driver can be used to place needles accurately in the nerve and facet regions. Clinical studies are required to investigate the advantages and disadvantages of this system for interventional procedures involving needles.