Robot-assisted minimally invasive lung brachytherapy.

BACKGROUND This paper presents a novel alternative for the treatment of lung cancer. The method consists of accessing the lung through small incisions in a minimally invasive manner in order to insert radioactive seeds directly into the lung using a robotic surgical system. METHODS An experimental test-bed to evaluate the feasibility of this approach has been developed. It consists of two surgical robotic systems, a device specifically designed to robotically implant radioactive seeds, needle tracking software, ultrasound imaging, electromagnetic tracking, and a surgical box that mimics a patient's thorax. A detailed comparison has been performed between currently available access options and robot-assisted minimally invasive access. RESULTS The results show insignificant differences in accuracy between the methods, with the exception of a significant improvement when electromagnetic (EM) guidance was added to the non-robotic techniques. The navigation system reduced the number of attempts for all seed delivery methods. Significant reductions in time were achieved in the minimally invasive procedures by the addition of EM guidance. CONCLUSIONS The performance achieved when using robotic systems and image guidance for minimally-invasive brachytherapy is clinically comparable to that achieved in an open surgery procedure, while reducing the invasiveness of the procedure, improving ergonomic conditions for the clinician and reducing radiation exposure.