Search Results (29)

Intraoperative ultrasound (IOUS) has developed from a rudimentary adjunct into a versatile modality that now plays a crucial role in neurosurgery. Offering real-time, radiation-free and repeatable imaging at the surgical site, it provides distinct advantages over intraoperative magnetic resonance (MRI) and computed tomography (CT) in terms of accessibility, workflow integration and cost. The clinical spectrum of IOUS is broad: in cranial surgery it enhances the extent of resection of gliomas and metastases, supports dissection in meningiomas and enables localization of MRI-negative pituitary adenomas; in spinal surgery, it guides resection of intradural and intramedullary tumors, assists in myelotomy planning and confirms decompression in degenerative conditions such as cervical myelopathy and ossification of the posterior longitudinal ligament. IOUS also offers unique insights into cerebrospinal fluid disorders, including arachnoid webs, cysts, syringomyelia and Chiari malformation, where it visualizes cord compression and CSF flow restoration. In trauma and oncological emergencies, it provides immediate confirmation of decompression, directly influencing surgical decisions. Recent innovations, including contrast-enhanced ultrasound, elastography, three-dimensional navigated systems and experimental integration with artificial intelligence and robotics, are extending its functional scope. Despite heterogeneity of evidence and operator dependence, IOUS is steadily transitioning from an adjunctive tool to a cornerstone of multimodal intraoperative imaging, bridging precision, accessibility and innovation in contemporary neurosurgical practice. Full article

Background: The diagnostic work-up of small peripheral pulmonary nodules (PPNs) is becoming increasingly important, especially in light of the upcoming lung cancer screening programs and recommendations in practice. The systematic clinical introduction of the ION robotic-assisted navigational bronchoscopy (RNB) system represents a significant innovation in Germany, whereas clinical experience in the United States has already yielded promising results. The objective of this study is to present the outcomes of the first 50 patients examined with the ION system at our institutions. Materials and Methods: This is a retrospective, single-center analysis. We included the first 50 consecutive patients who underwent diagnostic evaluation of pulmonary nodules using the ION-RNB system, either in the Department of Thoracic Surgery or the Department of Pulmonology. Results: A total of 50 patients were evaluated, including 24 from the Department of Thoracic Surgery and 26 from the Department of Pulmonology. The pulmonary nodules were found in the peripheral third of the lung in 74% of cases, in the middle third in 18% of cases, and in the central third in 8% of cases. The mean lesion size was 1.64 cm (±0.91 cm). In all, 84% of the nodules were solid, 4% were subsolid, and 12% presented as ground-glass opacities (GGOs). Cone beam computed tomography (CBCT) was used to confirm tool-in-lesion position in 68% of cases compared to C-arm fluoroscopy in 32%. Additionally, radial endobronchial ultrasound (rEBUS) was applied in 30% of procedures. The overall diagnostic yield, independent of imaging modality or histological processing method, was 78%. When CBCT and formalin-fixed paraffin-embedded (FFPE) histological analysis were utilized, the diagnostic yield exceeded 90%. Conclusions: Initial clinical experience with the ION-RNB system in Germany shows encouraging results. The high diagnostic accuracy underlines the system’s potential for evaluating peripheral pulmonary lesions precisely. The use of advanced imaging techniques, particularly CBCT, and the choice of histopathological processing methods are critical variables in optimizing patient-centered diagnostic pathways. Further prospective studies are warranted to assess the long-term clinical utility of robotic-assisted bronchoscopy in diverse clinical settings. Full article

Pancreatic pseudocysts (PPCs) are frequent complications of acute and chronic pancreatitis, characterized by encapsulated collections of pancreatic fluid. Historically managed by open surgical approaches, treatment paradigms have significantly evolved with advancements in imaging and minimally invasive techniques. This review outlines the historical progression and current standards in PPC management, covering conservative, surgical, laparoscopic, and endoscopic interventions. Conservative management remains a valid first-line option for asymptomatic, stable pseudocysts, particularly in the absence of complications. Surgical techniques, once the mainstay, such as marsupialization and internal drainage procedures (cystogastrostomy, cystojejunostomy, and cystoduodenostomy), now serve as alternatives when less invasive methods fail. Laparoscopic approaches offer reduced morbidity and faster recovery, especially for complex or inaccessible PPCs. However, endoscopic drainage, particularly endoscopic ultrasound-guided transmural drainage using plastic or metal stents—especially lumen-apposing metal stents (LAMSs)—has become the preferred modality due to its efficacy, safety profile, and cost effectiveness. Emerging technologies, including robotic-assisted surgery and hybrid techniques, promise further refinement in PPC management. This review synthesizes current evidence and expert guidelines, providing a comprehensive overview of evolving strategies and future directions in the treatment of PPCs. Full article

This paper presents the PRONOBIS project, an ultrasound-only, robotically assisted, deep learning-based system for prostate scanning and biopsy treatment planning. The proposed system addresses the challenges of precise prostate segmentation, reconstruction and inter-operator variability by performing fully automated prostate scanning, real-time CNN-transformer-based image processing, 3D prostate reconstruction, and biopsy needle position planning. Fully automated prostate scanning is achieved by using a robotic arm equipped with an ultrasound system. Real-time ultrasound image processing utilizes state-of-the-art deep learning algorithms with intelligent post-processing techniques for precise prostate segmentation. To create a high-quality prostate segmentation dataset, this paper proposes a deep learning-based medical annotation platform, MedAP. For precise segmentation of the entire prostate sweep, DAF3D and MicroSegNet models are evaluated, and additional image post-processing methods are proposed. Three-dimensional visualization and prostate reconstruction are performed by utilizing the segmentation results and robotic positional data, enabling robust, user-friendly biopsy treatment planning. The real-time sweep scanning and segmentation operate at 30 Hz, which enable complete scan in 15 to 20 s, depending on the size of the prostate. The system is evaluated on prostate phantoms by reconstructing the sweep and by performing dimensional analysis, which indicates 92% and 98% volumetric accuracy on the tested phantoms. Three-dimansional prostate reconstruction takes approximately 3 s and enables fast and detailed insight for precise biopsy needle position planning. Full article

(1) Background: Lymphedema is a common but underrecognized sequela of cancer treatment. Supermicrosurgical procedures such as lymphaticovenular anastomosis (LVA) and, more recently, lymph node-to-vein anastomosis (LNVA) have emerged as effective options for fluid-predominant disease. In 2024, we began performing robot-assisted LNVA using a next-generation microsurgical robot. This study describes our initial experience, technical insights, and the potential for robotics to extend the boundaries of supermicrosurgery. (2) Methods: Twenty-two consecutive robotic LNVAs were performed by a high-volume supermicrosurgeon at a tertiary center. Preoperative imaging with standard and ultra-high frequency ultrasound was used to identify optimal lymph nodes and veins. Robotic LNVA was performed using the Symani Surgical System, with adaptations for motion scaling, ergonomics, and console control. Intraoperative patency was confirmed by direct washout and/or indocyanine green (ICG) transit. (3) Results: All 22 procedures were technically successful, with 100% intraoperative patency. Anastomosis time improved from 37 to 18 min. Robotic assistance enhanced precision, eliminated tremors, and reduced the technical burden of operating at extreme submillimeter scales. (4) Conclusions: Robotic LNVA is safe, feasible, and efficient. It optimizes current techniques, offering the potential to extend surgical access below the 0.1 mm threshold, with implications for future treatment of lymphatic and possibly intracranial disease. Full article

Iatrogenic ureteral strictures are uncommon but challenging to manage. We present our expertise in laparoscopic and robot-assisted laparoscopic ureteroureterostomy (LUU and RAUU) for lumbar and iliac strictures and laparoscopic ureteral reimplantation for pelvic strictures. A descriptive study was conducted on nine adult patients who underwent minimally invasive procedures. Six had lumbar or iliac ureteral strictures—five due to ureterorenoscopy and one following pancreaticoduodenectomy for pancreatic cancer. Three developed pelvic strictures after ureterorenoscopy. Preoperative evaluation included a medical history review, abdominal ultrasound, and CT scan. Success was characterized by the absence of symptoms and the lack of obstruction on follow-up imaging at one year. All procedures were technically feasible, with a median operating time of 105 min and a median hospital stay of four days. No major complications occurred. One patient experienced ureteral stricture recurrence following a laparoscopic approach for a lumbar stricture, and required a permanent double-J stent. At a median follow-up of 38 months, 88.88% of patients remained asymptomatic with preserved renal function. Our findings suggest that robotic and laparoscopic ureteral reconstruction performed by experienced surgeons at a tertiary center is a safe and effective option with a low complication rate. Full article

The accurate assessment of muscle morphology and function is crucial for medical diagnostics, rehabilitation, and biomechanical research. This study presents a novel methodology for constructing volumetric models of forearm muscles based on three-dimensional ultrasound imaging integrated with a robotic system to ensure precise probe positioning and controlled pressure application. The proposed ultrasound scanning approach combined with a collaborative six-degrees-of-freedom robotic manipulator enabled reproducible and high-resolution imaging of muscle structures in both relaxed and contracted states. A custom-built phantom, acoustically similar to biological tissues, was developed to validate the method. The cross-sectional area of the muscles and the coordinates of the center of mass of the sections, as well as the volume and center of gravity of each muscle, were calculated for each cross-section of the reconstructed forearm muscle models at contraction. The method’s feasibility was confirmed by comparing the reconstructed volumes with anatomical data and phantom measurements. This study highlights the advantages of robotic-assisted ultrasound imaging for non-invasive muscle assessment and suggests its potential applications in neuromuscular diagnostics, prosthetics design, and rehabilitation monitoring. Full article

Background/Objectives: Robot-assisted bronchoscopy (RAB) is a novel platform for sampling peripheral pulmonary nodules (PPNs). To further clarify the role robot-assisted platforms have in diagnosing PPNs, we performed a review of the recent literature. Methods: A systematic review was performed in Medline from 2019 to 2024 using the search terms “robotic bronchoscopy”, “diagnostic yield”, “sensitivity”, and “positive predictive value”, alone and in combination. Studies that focused on earlier electromagnetic bronchoscopies were excluded. The patient demographic information, nodule characteristics, intra-procedure imaging modality, biopsy methods, diagnostic yield, sensitivity for malignancy, and adverse outcomes were analyzed. A total of 22 studies were available for the analyses. Results: The diagnostic yield was variable and ranged from 69 to 93%, with a median of 86%. The sensitivity ranged from 69% to 91.7%, with a median of 85%. The effect of the nodule size on the diagnostic yield was variable across the literature. Obtaining an eccentric or concentric view on a radial endobronchial ultrasound (rEBUS) was associated with a higher diagnostic yield than obtaining no view. A nodule appearance on CT imaging and the location were not definitively associated with a higher diagnostic yield. Fine needle aspiration usage ranged from 93.5 to 100%, with a median of 96.95%, while the use of biopsy forceps ranged from 2.7 to 96%, with a median of 69.9%. The most common complication was a pneumothorax, which occurred in 1–5.7% of cases, with a median of 1.6%. Conclusions: Robot-assisted transbronchial biopsies produce diagnostic yields that approach those of transthoracic needle aspirations. The nodule location and appearance may not affect the diagnostic yield. Obtaining a concentric or eccentric view on rEBUS is likely associated with an increased diagnostic yield. Additional prospective studies would better inform practitioners as this technology becomes more widespread. Full article

Ultrasound imaging is widely valued for its safety, non-invasiveness, and real-time capabilities but is often limited by operator variability, affecting image quality and reproducibility. Robot-assisted ultrasound may provide a solution by delivering more consistent, precise, and faster scans, potentially reducing human error and healthcare costs. Effective force control is crucial in robotic ultrasound scanning to ensure consistent image quality and patient safety. However, existing robotic ultrasound systems rely heavily on expensive commercial force sensors or the integrated sensors of commercial robotic arms, limiting their accessibility. To address these challenges, we developed a cost-effective, lightweight, 3D-printed force sensor and a hybrid position–force control strategy tailored for robotic ultrasound scanning. The system integrates patient-to-robot registration, automated scanning path planning, and multi-sensor data fusion, allowing the robot to autonomously locate the patient, target the region of interest, and maintain optimal contact force during scanning. Validation was conducted using an ultrasound-compatible abdominal aortic aneurysm (AAA) phantom created from patient CT data and healthy volunteer testing. For the volunteer testing, during a 1-min scan, 65% of the forces were within the good image range. Both volunteers reported no discomfort or pain during the whole procedure. These results demonstrate the potential of the system to provide safe, precise, and autonomous robotic ultrasound imaging in real-world conditions. Full article

Ultrasound imaging is commonly used for medical triage in both civilian and military emergency medicine sectors. One specific application is the eFAST, or the extended focused assessment with sonography in trauma exam, where pneumothorax, hemothorax, or abdominal hemorrhage injuries are identified. However, the diagnostic accuracy of an eFAST exam depends on obtaining proper scans and making quick interpretation decisions to evacuate casualties or administer necessary interventions. To improve ultrasound interpretation, we developed AI models to identify key anatomical structures at eFAST scan sites, simplifying image acquisition by assisting with proper probe placement. These models plus image interpretation diagnostic models were paired with two real-time eFAST implementations. The first implementation was a manual AI-driven ultrasound eFAST tool that used guidance models to select correct frames prior to making any diagnostic predictions. The second implementation was a robotic imaging platform capable of providing semi-autonomous image acquisition combined with diagnostic image interpretation. We highlight the use of both real-time approaches in a swine injury model and compare their performance of this emergency medicine application. In conclusion, AI can be deployed in real time to provide rapid triage decisions, lowering the skill threshold for ultrasound imaging at or near the point of injury. Full article

Background: The pathophysiology of median arcuate ligament syndrome (MALS) is poorly understood. The diagnostic process remains inadequately standardized, with an absence of precise criteria to guide therapeutic management. Methods: We studied consecutive subjects referred to the Department of Angiology at the University Hospital of Zurich over the past 17 years due to suspected MALS. We focused on (1) the imaging criteria that led to diagnosis, notably the results of color duplex ultrasound and the consistency with different imaging tests; (2) the clinical consequences focusing on symptom resolution. Results: We included 33 subjects; in 8 subjects (24.2%), the diagnosis of MALS was retained. The median expiration peak systolic velocity (PSV) on ultrasound was 3.05 (Q1; 2.1–Q3; 3.3). To confirm the sonographic results, either a CT or MRI was performed on all patients, with consistent findings confirming a significant stenosis. Seven patients underwent surgery, all involving arcuate ligament release. Four procedures were laparoscopic, one was via laparotomy, and two were robot-assisted. Additionally, two patients required angioplasty with stenting as a secondary intervention. Only two (28.6%) of the seven operated patients experienced a relief of symptoms. None experienced a relief of symptoms following secondary angioplasty, despite stent patency. The prevalence of psychiatric disorders was comparable between patients with retained and rejected diagnoses, 38% and 36%, respectively. Conclusions: Our study confirmed sonography and CT/MRI consistency. However, most patients with MALS did not benefit from invasive treatment. The majority (83%) of patients without MALS were diagnosed with alternative conditions, mainly functional disorders. Full article

The development of a new generation of minimally invasive surgery is mainly reflected in robot-assisted diagnosis and treatment methods and their clinical applications. It is a clinical concern for robot-assisted surgery to use a multi-joint robotic arm performing human ultrasound scanning or ultrasound-guided percutaneous puncture. Among them, the motion control of the robotic arm, and the guiding and contact scanning processes of the ultrasonic (US-) probe determine the diagnosis effect, as well as the accuracy and safety of puncture surgery. To address these challenges, this study developed an intelligent robot-assisted system integrating autonomous US inspection and needle positioning, which has relation to several intelligent algorithms such as adaptive flexible control of the robot arm, autonomous US-scanning, and real-time attitude adjustment of the puncture needle. To improve the cooperativity of the spatial operation of the robot end-effector, we propose an adaptive flexible control algorithm that allows the operator to control the robot arm flexibly with low damping. To achieve the stability and uniformity of contact detection and imaging, we introduced a self-scanning method of US-probe based on reinforcement learning and built a software model of variable stiffness based on MuJoco to verify the constant force and velocity required by the end mechanism. We conducted a fixed trajectory scanning experiment at a scanning speed of 0.06 m/s. The force curve generally converges towards the desired contact force of 10 N, with minor oscillations around this value. For surgical process monitoring, we adopted the puncture needle detection algorithm based on Unet++ to acquire the position and attitude information of the puncture needle in real time. In short, we proposed and verified an adaptive control method and learning strategy by using an UR robotic arm equipped with a US-probe and puncture needle, and we improved the intelligence of the US-guided puncture robot. Full article

This contribution is part of the objective of diligent universal care that ensures the well-being of a patient. It aims to analyze and propose enriched image-guided procedures for surgical interventions and restricted delivery of implanted drugs in minimally invasive and non-ionizing circumstances. This analysis is supported by a literature review conducted in two ways. The first aims to illustrate the importance of recent research and applications involved in different topics of the subject; this is mainly the case for the introduction’s literature. The second concerns the literature dedicated to having more detailed information in context; this mainly concerns the citations in the different sections of the article. The universal goals of medical treatments are intended to involve the well-being of the patient and allow medical personnel to test new therapies and carry out therapeutic training without risk to the patient. First, the various functionalities involved in these procedures and the concerns of the magnetic resonance imaging technique (MRI) and ultrasound imaging technique (USI), recent contributions to the subject are reviewed. Second, the intervention procedures guided by the image and the implemented actions are analyzed. Third, the components of the fields involved in MRI are examined. Fourth, the MRI control of the treatments, its performance and its compliance are analyzed. Compatibility with MRI via electromagnetic compatibility (EMC) is conferred and demonstrated for an actuation example. Fifth, the extension of the concepts mentioned in the article, in the context of patient comfort and the training of medical staff is proposed. The main contribution of this article is the identification of the different strategic aids needed in healthcare related to image-assisted robotics, non-ionized, minimally invasive and locally restrictive means. Furthermore, it highlights the benefits of using phantoms based on real biological properties of the body, digital twins under human control, artificial intelligence tools and augmented reality-assisted robotics. Full article

Bronchoscopy has garnered increased popularity in the biopsy of peripheral lung lesions. The development of navigational guided bronchoscopy systems along with radial endobronchial ultrasound (REBUS) allows clinicians to access and sample peripheral lesions. The development of robotic bronchoscopy improved localization of targets and diagnostic accuracy. Despite such technological advancements, published diagnostic yield remains lower compared to computer tomography (CT)-guided biopsy. The discordance between the real-time location of peripheral lesions and anticipated location from preplanned navigation software is often cited as the main variable impacting accurate biopsies. The utilization of cone beam CT (CBCT) with navigation-based bronchoscopy has been shown to assist with localizing targets in real-time and improving biopsy success. The resources, costs, and radiation associated with CBCT remains a hindrance in its wider adoption. Recently, digital tomosynthesis (DT) platforms have been developed as an alternative for real-time imaging guidance in peripheral lung lesions. In North America, there are several commercial platforms with distinct features and adaptation of DT. Early studies show the potential improvement in peripheral lesion sampling with DT. Despite the results of early observational studies, the true impact of DT-based imaging devices for peripheral lesion sampling cannot be determined without further prospective randomized trials and meta-analyses. Full article

Background: The aim of this study was to determine the false negative rates of prebiopsy magnetic resonance imaging (MRI) and MRI–ultrasound (US) 12-core systematic prostate biopsy (PBx) by analyzing radical prostatectomy specimens. Methods: This retrospective study included 3600 prostate cancer (PCa) patients who underwent robot-assisted laparoscopic radical prostatectomy. Based on comparison of lobe-specific data on final pathology with preoperative biopsy and imaging data, the study population was subdivided into group I—contralateral (CL) benign PBx (n = 983), group II—CL and/or bilateral (BL) non-suspicious mpMRI (n = 2223) and group III—CL benign PBx + non-suspicious mpMRI (n = 688). This population was studied for the presence of PCa, clinically significant PCa (csPCa), extracapsular extension (ECE) (pathological stage pT3), positive frozen section and final positive surgical margin (PSM) in the CL lobe. Descriptive statistics were performed. Results: In subgroups I, II and III, PCa was respectively detected in 21.5%, 37.7% and 19.5% of cases, and csPCa in 11.3%, 16.3% and 10.3% of cases. CL pT3 disease was seen in 4.5%, 4% and 5.5%, and CL surgical margins and/or frozen section analysis were positive in 6%, 7% and 5% of cases in subgroups I, II and III, respectively. Conclusions: There are still significant rates of false negatives in the standard care diagnostics of PCa. Further strategies are required to improve the accuracy of diagnosis and determination of tumor location. Full article