Ultrasound-guided Percutaneous Puncture Research Articles

An Ultrasound-Guided Miniature Hand-Eye Integrated Robot for Percutaneous Needle Placement

Abstract Ultrasound-guided percutaneous puncture technology has advantages such as intra-operative real-time imaging, noninvasive operation, high targeting accuracy, nonionizing radiation, and low cost. However, traditional percutaneous puncture surgery requires doctors to hold ultrasound probes or puncture needles, which causes complex operations. In this article, by integrating ultrasound and needle insertion mechanisms, an ultrasound-guided miniature puncture robot is proposed. This robot can work without an external navigation or industrial or cooperative manipulator after hand-eye calibration and acknowledge the coordinate relationship between the ultrasound image and the robot tip. A three degrees-of-freedom (DoFs) of in-plane mechanism using linear actuators is designed so that the puncture needle can always be scanned by ultrasound during the operation, ensuring real-time monitoring. The method of planning puncture path, modeling the robot kinematics, and ultrasound hand-eye calibration are proposed. To track a needle in an ultrasound image, the image recognition and filter algorithm for the needle tip are presented. The accuracy of the robot puncture operation is verified by point targeting and path tracking experiments in the water tank and phantom, and the puncture error of the robot is 1.5 ± 0.5 mm in the water tank, 1.98 mm in the abdominal phantom, and 1.41 mm in the breast phantom. Finally, the work of this article effectively improves the availability and effectiveness of the ultrasound-guided puncture robot.

Ultrasound-Guided Percutaneous Puncture Combined With Continuous Pressure Dressing for Treating Subcutaneous Fluid Accumulation in the Bone Window Area After Decompressive Craniectomy.

Subcutaneous fluid accumulation in the bone window area is a common complication after decompressive craniectomy. If not promptly addressed, it may progress to serious complications such as intracranial infection and hydrocephalus, significantly affecting treatment outcomes and prognosis. However, there is currently no standardized approach for managing subcutaneous fluid accumulation. Ultrasound-guided percutaneous puncture in the bone window area can directly decrease the accumulated fluid; moreover, when combined with continuous pressure dressing, this approach can effectively eliminate subcutaneous fluid in a short period, prevent severe complications, and enhance patient recovery outcomes.

Diagnosis of multiple tuberculous muscle abscesses in a patient with systemic lupus erythematosus by metagenomic next-generation sequencing- a case report and literature review

BackgroundEarly diagnosis of muscular tuberculosis (TB) without coexistent active skeletal involvement is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of muscular TB, we present a case of multiple tuberculous muscle abscesses in a systemic lupus erythematosus (SLE) female, but without pulmonary tuberculosis (PTB), in order to increase awareness of and stress the need of early detection of muscular TB.Case presentationA 44-year-old woman with a 6-year history of SLE who had been treated with methylprednisolone for a long time complained of erythema on her trunk and extremities for five months, along with edema and myalgia for two months, and fever for one month. The patient was first misdiagnosed as SLE overlap dermatomyositis. However, an ultrasound-guided drainage of muscle abscesses revealed positive acid-fast staining combined with positive deoxyribonucleic acid fragment of Mycobacterium tuberculosis using metagenomic next-generation sequencing (mNGS). The patient was cured and released following standard anti-tuberculosis medication, local puncture drainage, and an intravitreal injection of streptomycin. Literature search found only 19 cases of tuberculous muscle abscesses occurring in the extremities reported from 1999 to 2023.ConclusionsExtrapulmonary TB with predominantly muscle involvement is rare and with no specific clinical presentation. Muscular tuberculosis may be disdiagnosed for dermatomyositis due to the high muscle enzyme levels, delaying diagnosis and treatment. mNGS technology is helpful in the early and rapid diagnosis of muscular TB. On the basis of traditional anti-tuberculosis treatment, an ultrasound-guided percutaneous puncture drainage and intracavitary injection of streptomycin for the treatment of tuberculous muscle abscess is easy to operate, safe and effective, which is worthy of clinical popularization and application.

An Adaptive Control Method and Learning Strategy for Ultrasound-Guided Puncture Robot

The development of a new generation of minimally invasive surgery is mainly reflected in robot-assisted diagnosis and treatment methods and their clinical applications. It is a clinical concern for robot-assisted surgery to use a multi-joint robotic arm performing human ultrasound scanning or ultrasound-guided percutaneous puncture. Among them, the motion control of the robotic arm, and the guiding and contact scanning processes of the ultrasonic (US-) probe determine the diagnosis effect, as well as the accuracy and safety of puncture surgery. To address these challenges, this study developed an intelligent robot-assisted system integrating autonomous US inspection and needle positioning, which has relation to several intelligent algorithms such as adaptive flexible control of the robot arm, autonomous US-scanning, and real-time attitude adjustment of the puncture needle. To improve the cooperativity of the spatial operation of the robot end-effector, we propose an adaptive flexible control algorithm that allows the operator to control the robot arm flexibly with low damping. To achieve the stability and uniformity of contact detection and imaging, we introduced a self-scanning method of US-probe based on reinforcement learning and built a software model of variable stiffness based on MuJoco to verify the constant force and velocity required by the end mechanism. We conducted a fixed trajectory scanning experiment at a scanning speed of 0.06 m/s. The force curve generally converges towards the desired contact force of 10 N, with minor oscillations around this value. For surgical process monitoring, we adopted the puncture needle detection algorithm based on Unet++ to acquire the position and attitude information of the puncture needle in real time. In short, we proposed and verified an adaptive control method and learning strategy by using an UR robotic arm equipped with a US-probe and puncture needle, and we improved the intelligence of the US-guided puncture robot.

Online advance respiration prediction model for percutaneous puncture robotics.

Surgical robots have significant research value and clinical significance in the field of percutaneous punctures. There have been numerous studies on ultrasound-guided percutaneous surgical robots; however, addressing the respiratory compensation problem of deep punctures remains a significant obstacle. Herein we propose a robotic system for percutaneous puncture with respiratory compensation. We proposed an online advance respiratory prediction model based on Bidirectional Gate Recurrent Unit (Bi-GRU) for the respiratory prediction requirements of surgical robot systems. By analyzing the main factors governing the accuracy of the respiratory motion prediction models, various parameters of the online advance prediction model were optimized. Subsequently, we integrated and developed ultrasound-guided percutaneous puncture robot software and a hardware platform to implement respiratory compensation, thus verifying the effectiveness and reliability of various key technologies in the system. The proposed respiratory prediction model has a significantly reduced update time, with an average root mean square error (RMSE) of less than 0.4mm. This represents a reduction of ~ 20% compared to the online training long short-term memory(LSTM). By conducting puncture experiments based on a respiratory phantom, the average puncture error was 2.71 ± 0.65mm and the average single-round puncture time was 65.00 ± 6.67s. Herein we proposed and optimized an online training respiratory prediction network model based on Bi-GRU. The stability and reliability of this system are verified by conducting puncture experiments on a respiratory phantom.

Ultrasound-guided periadventitial administration of rapamycin-fibrin glue attenuates neointimal hyperplasia in the rat carotid artery injury model

IntroductionArterial restenosis caused by intimal hyperplasia (IH) is a serious complication after vascular interventions. In the rat carotid balloon injury model, we injected phosphate buffer saline (PBS), rapamycin-phosphate buffer saline suspension (RPM-PBS), blank fibrin glue (FG) and rapamycin-fibrin glue (RPM-FG) around the injured carotid artery under ultrasound guidance and observed the inhibitory effect on IH. MethodsThe properties of RPM-FG in vitro were verified by scanning electron microscopy (SEM) and determination of the drug release rate. FG metabolism in vivo was observed by fluorescence imaging. The rat carotid balloon injury models were randomly classified into 4 groups: PBS group (control group), RPM-PBS group, FG group, and RPM-FG group. Periadventitial administration was performed by ultrasound-guided percutaneous puncture on the first day after angioplasty. Carotid artery specimens were analyzed by immunostaining, Evans blue staining and hematoxylin-eosin staining. ResultsThe RPM particles showed clustered distributions in the FG block. The glue was maintained for a longer time in vivo (> 14 days) than in vitro (approximately 7 days). Two-component liquid FG administered by ultrasound-guided injection completely encapsulated the injured artery before coagulation. The RPM-FG inhibited IH after carotid angioplasty vs. control and other groups. The proliferation of vascular smooth muscle cells (VSMCs) was significantly inhibited during neointima formation, whereas endothelial cell (EC) repair was not affected. ConclusionPeriadventitial delivery of RPM-FG contributed to inhibiting IH in the rat carotid artery injury model without compromising re-endothelialization. Additionally, FG provided a promising platform for the future development of a safe, effective, and minimally invasive perivascular drug delivery method to treat vascular disease.

Determination of the diagnostic potential of research methods in the differentiation of pancreatic cancer and chronic pancreatitis based on evidence-based medicine

Background. Currently, the use of the principles of evidence-based medicine is an integral part of assessing the effectiveness and safety of modern technology for the diagnosis and treatment of any disease or clinical condition. Differential diagnosis of pancreatic cancer and chronic pancreatitis is one of the most controversial issues in surgical pancreatology. The reduced number of cases of resectable pancreatic cancer indicates the need to develop programs for the differentiation of these pathologies with the wide implementation of modern diagnostic methods.
 Purpose − to compare the results of diagnostic methods (which are standardly used in accordance with clinical guidelines for the diagnosis of chronic pancreatitis) based on evidence-based medicine and quantitative assessments of their specificity, sensitivity, and general accuracy in terms of the differential diagnosis of chronic pancreatitis and pancreatic cancer in order to determine the most significant results for the differentiation of these pathologies.
 Materials and methods. The results of diagnostic methods were compared in 80 patients, among them 38 (47.5%) had pancreatic cancer, and 42 (52.5%) − chronic pancreatitis with predominant lesion of the pancreatic head. The patients underwent general clinical blood and urine tests, biochemical blood tests, and the following procedures and examinations available in the clinic: ultrasound examination of the abdominal organs, spiral computed tomography, fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, CA 19-9 tumor marker test, ultrasound-guided percutaneous puncture of the pancreas, aspiration of pancreatic juice, urgent intraoperative biopsy, and histological examination of surgically resected areas of the pancreas. Based on the received data, we performed a comparison of their quality, accuracy, and informativeness.
 Results. Ultrasound imaging is a screening method for suspected pancreatic cancer, however, the overall accuracy, sensitivity, and specificity of the method are quite low (82.5%, 76.32%, 88.10%, respectively). When analyzing the qualitative characteristics of endoscopic retrograde cholangiopancreatography, the overall accuracy, sensitivity, and specificity indicators for the differential diagnosis of pancreatic cancer were 71%, 78.6%, and 63.3%, respectively. The interval assessment of the accuracy of the method of transcutaneous biopsy of the pancreas aimed at determining chronic pancreatitis was (34.9; 96.8)%; for pancreatic cancer – (8.5; 75.5)%. The interval assessment of the accuracy of the method of endoscopic aspiration of pancreatic juice for chronic pancreatitis was (6.8; 93.2)%; for pancreatic cancer – (19.4; 99.4)%. An increase in the level of CA 19-9 was found in 40.5% of patients (CI95% from 27.0% to 55.5%), while the average level was significantly higher in pancreatic cancer. The level of the CA 19-9 tumor marker depended on the size of the tumor and the spread of the process, and during the dynamic observation in the settings of treatment, it had a tendency to decrease, which indicated chronic pancreatitis. The significance of intraoperative morphological verification of the diagnosis of pancreatic cancer in histological examination was 98%, in cytological examination – 95.3%, in 4.7% urgent intraoperative biopsy was questionable. In all examinations, the surrounding tumor tissue showed a morphological pattern of chronic pancreatitis, in 36 (88%) cases – with foci of metaplasia and intraductal neoplasia of the epithelium, which can be considered as a background for the development of intraductal adenocarcinoma. At the same time, cancerous occlusion of the ducts led to their expansion above the point of narrowing with pronounced fibrous changes and inflammatory reaction of the stroma that was accompanied by widespread atrophy of the parenchyma.
 Conclusions. On the basis of evidence-based medicine, it was established that spiral computed tomography is the most informative method for the differential diagnosis of pancreatic cancer with chronic pancreatitis, with an overall accuracy of 92.2%, sensitivity of 89.2%, and specificity of 95%. The low qualitative indicators of ultrasound diagnostics can be increased due to its complex combination with the CA 19-9 tumor marker test with an overall accuracy of 92.3%, with sensitivity and specificity of 95% and 91%, respectively, which is significantly different from such indicators when the method was used separately (82.5%, 76.3%, and 88.1%, respectively). In the cases when the complex combination of endoscopic retrograde cholangiopancreatography with the measurement of the level of the CA 19-9 tumor marker was used, the overall accuracy of the method was 95.2%, with sensitivity of 95% and specificity of 95.5%, which is significantly different from such indicators obtained when the method was used separately (71%, 78.6% and 63.3%, respectively). Advances in modern imaging methods cannot replace histological examination as the «gold standard» for the correct determination of the morphological substrate of these pancreatic lesions.

Dual ultrasound-guided totally implantable venous access ports via the right internal jugular vein in pediatric patients with cancer: a preliminary experience in a single institution

ObjectiveTo assess the efficacy and safety of dual ultrasound-guided (DUG) totally implantable venous access port (TIVAP) implantation (namely, using ultrasound-guided percutaneous puncture with transesophageal echocardiography-guided catheterization) via the right internal...

A Preclinical Porcine Model of Portal Vein Thrombosis in Liver Cirrhosis.

Background This study aimed at presenting a novel method of developing a porcine model of portal vein thrombosis (PVT) in cirrhosis by intravenous administration of thrombin and insertion of a fibered coil. We further investigated changes of biochemical parameters, coagulation, and proinflammatory cytokine expression in the cirrhosis-PVT group. Methods Twelve male pigs were randomized into the control group (n = 3) and cirrhosis group (n = 9). In cirrhotic pigs, three were randomly selected to establish PVT by ultrasound-guided percutaneous puncture of the main portal vein (MPV) followed by intravenous thrombin administration and fibered coil insertion. Thrombosis in the MPV was detected by abdominal enhanced computer tomography (CT). The changes of hepatic function, coagulation system, and inflammation cytokines were compared among normal, cirrhosis, and cirrhosis with PVT groups. Results As manifested by the presence of a filling defect in MPV on portal venous-phase CT angiography, fibrin thrombi were formed in the MPV in cirrhotic pigs within one week and persisted for four weeks. Five weeks after surgery, abnormal liver functions occurred in association with PVT formation in cirrhosis. Both coagulation and thromboelastography parameters showed that cirrhosis-PVT pigs exhibited a procoagulant state through hyperfunction of platelets and clotting factors. Interleukin 6 (IL-6) as a potential inflammatory marker stimulated PVT-mediated inflammation activation in cirrhosis. Conclusions Our study provides in vivo evidence that intravenous injection of a coil and thrombin into MPV under interventional guided devices enables a feasible method in thrombus creation. Further exploration and validation of large-sample cases are required to characterize utilities of this model.

Ultrasound-Guided Percutaneous Arterial Puncture and Closure Device Training in a Pulsatile Model

The current study assesses the feasibility of in vitro practice of percutaneous puncture techniques in a pulsatile flow-model. Prospective, controlled, randomized study. The percutaneous access to endovascular aortic repair is considered safe, but success rates may be dependent on surgeon experience with the technique. Fourteen vascular surgery trainees and consultants were enrolled and randomized to a study or control group with both groups receiving instructions by a tutor on how to perform ultrasound guided percutaneous puncture and closure using a suture-mediated closure device. The study group received additional hands-on training on a pulsatile flowmodel of the groin and the performance of both groups was then graded. Study group participants were timed during and after their training on the model. The study group achieved higher overall grading than the control group on a 5-point scale with higher scores indicating a better performance (mean overall scores 4.0 ± 0.7 versus 2.8 ± 1.0, respectively; p = 0.03). Experienced participants (more than 20 punctures performed before the study) achieved higher overall scores than trainees (3.8 ± 0.4 versus 2.5 ± 0.8, respectively; p = 0.01). Five participants in the study group could deploy and close the ProGlide closure device correctly without the help of a tutor while being graded (71% in the study versus 0% in the control group; p = 0.02). Study group participants improved their overall score from 3.2 ± 0.9 to 4.0 ± 0.7 during training (p = 0.02). Time needed to complete the puncture and closure reduced from 456 seconds on average before, to 302 seconds after training (p < 0.001). Study group participants could improve their overall score while working on the simulator. More experienced participants performed better during the simulation, which may indicate the model to be life-like and a potential skills assessment tool. Simulation training may be a valuable adjunct to traditional forms of training when teaching an endovascular technique but is limited by its reliance on simulators and demo devices.

Embolización portal hepática preoperatoria con lipiodol y gelatina absorbible

ObjectiveTo evaluate outcomes of preoperative hepatic portal vein embolisation with lipiodol and absorbable gelatin in order to generate liver hypertrophy and enable right hepatectomy in selected patients with liver tumours and future insufficient residual liver. Materials and methodsPortal vein embolisation (PVE) with lipiodol and absorbable gelatin sponge mixed with iodine based contrast was performed in 18 patient candidates for right hepatectomy between March 2002 and April 2014. The pre-embolisation liver volume evaluations were performed by computed tomography with intravenous contrast. Patients underwent an ultrasound-guided percutaneous puncture, followed by angiography. The controls of hypertrophy and volume estimation were performed in the 4th week after portal embolisation. The patients were followed-up on an outpatient basis or by using their medical records. ResultsThe median age was 58 years, with a 1:0.8 male: female ratio. The total estimated liver volume, excluding the tumour, of all patients evaluated prior to surgery was 1587.75 cm3 (median). The previous estimated liver volume and its relation to the future remaining portion before PVE was 19.9%. The absolute median growth of future residual liver parenchyma post-PVE was 306.2 to 475.2 cm3, being an increase of 43.5%, and the mean growth of liver volume and remaining portion ratio post-PVE was 8.5% (P<.001). Complications were one haematoma and one aseptic necrosis. ConclusionThe selection of patients is of paramount importance, and PVE with lipiodol and absorbable gelatin in our environment is a safe and effective procedure.

Compression assisted by removable coils as a new treatment for iatrogenic femoral pseudoaneurysms

To avoid undesirable effects that sometimes result from current treatments for postpuncture femoral pseudoaneurysms, we developed a new technique involving compression assisted by removable coils. Using ultrasound-guided percutaneous puncture, an Inconel coil with synthetic microfibers is inserted in the pseudoaneurysm, leaving a part of the coil above the skin. Short-duration, ultrasound-guided compression is applied, taking advantage of the coil's thrombogenicity. Following occlusion, the coil is removed, leaving no residual foreign material. The technique was effective in the first patient treated and may minimize or obviate the adverse effects associated with current approaches.

Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection

To introduce and evaluate the new method used in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis (SAP). A total of 42 SAP patients initially underwent ultrasound-guided percutaneous puncture and catheterization. An 8-Fr drainage catheter was used to drain the infected peripancreatic necrotic foci for 3-5 d. The sinus tract of the drainage catheter was expanded gradually with a skin expander, and the 8-Fr drainage catheter was replaced with a 22-Fr drainage tube after 7-10 d. Choledochoscope-guided debridement was performed repeatedly until the infected peripancreatic tissue was effectively removed through the drainage sinus tract. Among the 42 patients, the infected peripancreatic tissue or abscess was completely removed from 38 patients and elective cyst-jejunum anastomosis was performed in 4 patients due to formation of pancreatic pseudocysts. No death and complication occurred during the procedure. Percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple, safe and reliable treatment procedure for peripancreatic infections secondary to SAP.

Sonographically assisted liver biopsy--replacement for blind needle biopsy?

Since the beginning of 1980 the authors have performed upper-abdominal ultrasound examination immediately preceding percutaneous needle biopsy (after Menghini), previously performed "blind". Knowledge of the particular liver topography made it possible to perform reliably punctures with only a small number of multiple punctures (6.4%) being required, suitable biopsies more often being obtained than under laporoscopic control. Compared with 354 consecutive blind liver biopsies, guided biopsy caused pain from the puncture in 1.9% (previously 5.9%), with a reduction of need for analgesics from 4.5% to 1.1%. The rate of more serious complications was reduced from five (1.4%) to one (0.2%), although as a result of ultrasound the indications for percutaneous liver biopsy were more frequent, since numerous "classical" contra-indications could be ignored. Blind liver biopsy should thus be abandoned for ultrasound-guided percutaneous puncture.

Renal Cysts: Can Percutaneous Ethanol Injections Be Considered an Alternative to Surgery?

Aim: To evaluate the efficacy of a new sclerotization technique with pure ethanol in the treatment of symptomatic renal cysts. Patients and Methods: Fourteen patients having renal cysts with a meant diameter of 10 (range 5–15) cm were treated. Our technique includes: ultrasound-guided percutaneous puncture with an 18-gauge needle, positioning of a 5-Fr catheter, complete cyst fluid aspiration, injection of pure alcohol equal to 15% of the initial cyst volume, and alcohol aspiration after 90 min. The procedure was repeated eight times within 5 days. The patients were followed up by ultrasound and/or CT scan for 1 year. Results: All patients became symptom free. Follow-up showed a progressive reduction of the cyst diameter in all cases. Three cysts only (in 2 patients; cyst diameter <2 cm) persisted after 12 months. No significant complications were observed. Conclusions: In our experience, injections of pure ethanol in renal cysts, repeated after some days, were effective in eliminating recurrences and related symptoms. The procedure was not associated with significant complications. Our findings suggest that it be considered the first-choice procedure in the treatment of renal cysts, due to the good results and the low cost of ethanol.