Cite as: APL Bioeng. 8, 021501 (2024); doi: 10.1063/5.0180494

Submitted: 10 October 2023 .

Accepted: 11 March 2024 .

Published Online: 1 April 2024

Hanglok in collaboration with Technical University of Munich, Zhongda Hospital Affiliated to Southeast University, and Guangzhou First People's Hospital, has achieved a significant milestone in medical innovation. Their collaborative effort has resulted in the publication of a groundbreaking review titled 'Robotic Systems for Thoracoabdominal Puncture' in APL Bioengineering, a prestigious journal with a JCR Q1 ranking and an impact factor of 6.586. This review, featured in the Interventional Surgery section of APL Bioengineering's Vol. 8, Issue 2 for 2024, highlights advancements in robotic technology poised to revolutionize interventional procedures.

Abstract of original text：

Cancer, with high morbidity and high mortality, is one of the major burdens threatening human health globally. Intervention procedures via percutaneous puncture have been widely used by physicians due to its minimally invasive surgical approach. However, traditional manual puncture intervention depends on personal experience and faces challenges in terms of precisely puncture, learning-curve, safety and efficacy. The development of puncture interventional surgery robotic (PISR) systems could alleviate the aforementioned problems to a certain extent. This paper attempts to review the current status and prospective of PISR systems for thoracic and abdominal application. In this review, the key technologies related to the robotics, including spatial registration, positioning navigation, puncture guidance feedback, respiratory motion compensation, and motion control, are discussed in detail.

Discovery

Current product systems lack real-time needle tip location (closed-loop real-time location at the end of the needle path compared to preoperative CT). Specifically, for tumor-oriented puncture interventional surgery, the patient is subject to complex noise such as flexible deformation, breathing, abnormal movement, etc. The physicians select the needle insertion path in the software based on a plain scan CT taken by the patient in a certain body state about 10-20 minutes ago. The spatial transformation relationship between the digital human body, near infrared camera and cooperative robot established solely through multiple landmarks by the robot itself, as well as predicting breathing patterns using body surface landmarks alone, cannot accurately establish a navigation mechanism. Interventionists must perform at least two CT scans of the patient to adjust the puncture needle position and reach their target. In particular, due to a lack of regulatory regulations and clinical consensus, piercing robots are currently unable to independently complete actions involving piercing into human bodies. Therefore, most schemes recommend this compromise strategy of choosing body surface pinholes which further amplifies patients' breathing behavior and natural movements that greatly impact positioning accuracy and piercing effectiveness. Additionally, when puncturing tissues like liver or stomach with flexible properties will experience uneven friction and cutting forces leading to increased errors. These problems hinder further development of PISR system; thus it is urgent to gradually solve them by combining more intelligent and reliable methods. The robot system needs greater doctor interaction so that puncture positioning/navigation systems can evolve towards an AI-assisted shared driving system controlled jointly by doctors and robots for precise control over targets (puncture needles).

PISR solutions have begun to show many common key technologies, and there are still many challenges to be overcome in order to further improve puncture accuracy and surgical efficiency. Drawing from their collective expertise amassed over the past three years, Hanglok and the team from the Technical University of Munich have collaborated with consultant experts to synthesize and share their knowledge in the field of puncture intervention robots. This collaboration culminated in the completion of a comprehensive review, showcasing their combined insights and contributions to the field.

Representative products for PISR

Robot-assisted puncture interventional procedures include

Research Breakthrough

The puncture intervention control system can be envisioned to evolve in the following dimensions.

Hardware innovation

In response to the imperative to minimize patient trauma, particularly in surgeries necessitating multiple puncture needles, advancements in the robot hardware structure are imperative. Innovations should encompass expanded kinematic joints and autonomous movement capabilities, alongside enhanced integration of puncture intervention scenarios, to augment the robot's versatility in complex procedures.

Information acquisition

By integrating ultrasound technology into the robot's navigation module, real-time information can be obtained and accurately adjusted to form a closed loop of navigation control. When combined with AI and advanced modeling techniques, the puncture interventional robot system is expected to achieve higher levels of accuracy in puncture procedures and exhibit enhanced intelligence.

Global awareness

Proposing a cross-modal global perception method is crucial for establishing a true closed-loop control loop for tumor puncture intervention in the PISR system, incorporating dimensional information from ultrasound and surgical instrument force feedback, alongside vision and speech, to create a comprehensive link between the surgical patient, physician, and robot, thereby moving beyond reliance solely on near-infrared optical/electromagnetic sensing information and CT for virtual navigation.

Dedicated operating system

The design and implementation of the PISR system should leverage the proprietary operating framework of interventional medical surgical robots. This approach ensures the establishment of exclusive and comprehensive communication protocols, facilitating seamless integration of diverse components. Moreover, it enables efficient interchangeability of key modules, thereby fostering interoperability across various functionalities. Such strategic alignment not only streamlines operations but also yields significant reductions in research and development expenditures. Ultimately, this initiative sets the foundation for the realization of a cutting-edge, multi-functional composite operating room of the future.