Initial experience of robotic-assisted ablation: a rapid learning curve leads to shorter procedures with less needle repositioning

Purpose: Stereotactic guidance for abdominal ablations has shown promise for faster and more accurate probe placement. This can be combined with robotic assistance for more precise probe placement, particularly with multi-needle and off-plane trajectories. The aim of this project was to describe an initial experience with robotic-assisted percutaneous ablations of abdominal lesions.

Materials and Methods: The first 39 consecutive patients who underwent percutaneous ablation using the Epione® robotic device (Quantum Surgical, France) were retrospectively analyzed. There were 24 men (62%), with a mean age 68 years (±12). The feasibility of the procedure, defined as successful robotic insertion of the needle (no occurrence of switching to freehand, robot access issue or device deficiency), safety, and duration of the procedure (planning to end of robotic-assisted needle placement) were assessed.

Results: 41 lesions, 33 (80.5%) liver, 4 (9.8%) kidney, 2 (4.9%) adrenal, were treated with robotic-assisted ablation. Thirty-two (78%) were treated with microwave technology and 9 (22%) were treated with cryoablation. A total of 59 needles were inserted with robotic assistance (36% procedures required multiple needles), including 79% off axial plane trajectories. 53/59 (90%) needles were successfully inserted with robotic assistance. Reasons for non-feasibility were robotic access (n=2) or switch to freehand procedure (n=4). These 6 occurrences were within the first 29 needles (21 first cases), none were reported in the last 30 needles (last 18 cases) (p=0.01). 4 complications (3 minor, 1 major (renal failure)) were reported, none related to the use of the robotic device. Needle placement was accurate with no or only minor manual depth adjustment in 71% of cases. A manual lateral adjustment was required in 24% needles. The total mean duration of robotic device use was 33 min (±17), which was higher at 40 min for the 21 first cases and 24 min for the 18 last cases (p=0.003).

Conclusion: Robotic-assisted thermal ablation of abdominal lesions is feasible, safe and had a rapid learning curve leading to less needle repositioning and faster procedures than very early experiences.