Abstract
BACKGROUND: Traditional freehand puncture relies on non-real-time computed tomography (CT) images, which significantly affects the accuracy of puncturing targets in the lower lung lobes with respiratory motion. This study aims to assess the safety and feasibility of a teleoperated robotic system and low-dose CT for the accurate real-time puncture of targets in the lungs of live pigs during breathing under fluoroscopic guidance. METHODS: Two puncture methods were analyzed: freehand and robot-assisted. For each method, one puncture was performed on a target implanted in the lower lung lobe of live pigs (five animals per group, two targets per animal), totaling 20 punctures. Using a tube current of 30 mA, group A received freehand punctures with conventional CT, while group B received robot-assisted punctures with real-time CT fluoroscopy. Data on operation time (OT), number of needle adjustments (NA), puncture time (PT), radiation dose (RD), and puncture accuracy were collected and analyzed. Statistical analysis was performed using SPSS version 26.0, and data were compared using a Mann-Whitney U test. RESULTS: The puncture accuracy rate was 100% in both groups. The RD was similar between the groups (P=0.25414). Nonetheless, the surgical robotic system was associated with a significantly shorter OT and PT and a smaller NA (P=0.00016, 0.00015, 0.00005). CONCLUSIONS: Teleoperated robotic systems combined with low-dose CT can accurately puncture millimeter-level targets in the lower lung lobes in real time during breathing under fluoroscopic guidance. Compared with freehand puncture with intermittent scans, the new technique reduces the NA and shortens the OT and PT. Moreover, this technique can improve the targeting and interventional treatment of tumors.