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

PLOS ONE, Dec 2019

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.

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

March Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy Shaoli Liu 0 1 2 Zeyang Xia 0 2 Jianhua Liu 0 1 2 Jing Xu 0 2 He Ren 0 2 Tong Lu 0 2 Xiangdong Yang 0 2 0 a Current address: School of Mechanical Engineering, Beijing Institute of Technology , Beijing , China ¤b Current address: Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, ShenZhen, China ¤c Current address: Department of Mechanical Engineering, Tsinghua University , Beijing , China ¤d Current address: Department of Ultrasound in Medicine, Navy General Hospital of PLA , Beijing , China ¤e Current address: Department of Ultrasound, the Chinese PLA General Hospital , Beijing , China 1 School of Mechanical Engineering, Beijing Institute of Technology , Beijing , China , 2 Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , ShenZhen , China , 3 Department of Mechanical Engineering, Tsinghua University , Beijing , China , 4 Department of Ultrasound in Medicine, Navy General Hospital of PLA , Beijing , China , 5 Department of Ultrasound, the Chinese PLA General Hospital , Beijing , China 2 Editor: Yujin Hoshida, Icahn School of Medicine at Mount Sinai , UNITED STATES 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, - OPEN ACCESS designed parts of the robot and agreed to publish the manuscript. Competing Interests: The authors have declared that no competing interests exist. 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. Introduction 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. In this technique, to destroy an entire malignant liver tumor, two important clinical considerations should be noted: tumor size and accessibility of the lesion. For example, 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 [1–3]. Such multiple overlapping MC is more difficult simply due to the placement of multiple needles. Thus, 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]. The RALTCT system and the surgery environment are shown in Fig 1. Based on the operation process, we know that preoperative planning is the most (...truncated)


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Shaoli Liu, Zeyang Xia, Jianhua Liu, Jing Xu, He Ren, Tong Lu, Xiangdong Yang. Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy, PLOS ONE, 2016, Volume 11, Issue 3, DOI: 10.1371/journal.pone.0149482