Abstract
Purpose
Current manual catheters for transbronchial biopsy in the lung lack a steering ability, which hampers a physician’s ability to reach nodules in the peripheral lung. The objective of this paper is to design and build a multisection robot with a follow-the-leader motion and compare the performance of the conventional catheter and our robotic catheter in the right main and right segmental lobar bronchus.
Methods
A three-section continuum robot with an outer diameter of 3 mm was developed. Each section includes one anchored wire and two driving wires made of stainless steel. Follow-the-leader control is implemented using a joystick for a physician to control the distal section of the robot, while the subsequent two sections follow the controlled distal section.
Results
The robotic catheter deviated from the preplanned approach path by less than the manual catheter did (robotic: \(0.94 \pm 0.50\) mm and manual: \(1.86 \pm 0.74\) mm), with \(p < 0.01\). The average force applied to the wall, producing potential trauma to the wall, was less for the robotic catheter (\(0.13 \pm 0.11\) N) than for the manual catheter (\(0.94 \pm 0.30\) N), \(p<0.001\).
Conclusion
This study demonstrated an improvement in the maneuverability for the robotic catheter. In addition to a greater aptitude for reaching a peripheral area of the lung, these findings suggest that the designated target in a peripheral area can be reached with less trauma to the bronchi wall.
Similar content being viewed by others
References
National Lung Screening Trial Research Team (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365(5):395–409
Rubin GD (2015) Lung nodule and cancer detection in CT screening. J Thorac Imaging 30(2):130
Folch EE, Pritchett MA, Nead MA, Bowling MR, Murgu SD, Krimsky WS, Murillo BA, LeMense GP, Minnich DJ, Bansal S, Ellis BQ, Mahajan AK, Gildea TR, Bechara RI, Sztejman E, Flandes J, Rickman OB, Sadia Benzaquen D, Hogarth K, Linden PA, Wahidi MM, Mattingley JS, Hood KL, Lin H, Wolvers JJ, Khandhar SJ, Anciano C, Aragaki A, Arenberg D, Awais O, Balestra R, Barisione E, Bechara R, Bezzi M, Bhadra K, Bird J, Blanco A, Bowling M, Cerfolio R, Christensen M, Cicenia J, Courey A, Doty J, Eggleston K, Ellis B, Fernandez I, Folch E, Furman A, Gass GD, Gildea T, Gogineni A, Grabcanovic MF, Hinze JD, Hogarth DK, Karunakara R, Kazakov J, Khandhar S, Khurana S, Krimsky W, Krishna G, Krol R, Kropfmüller R, Lamprecht B, Lau K, Lee A, LeMense G, Linden P, Lutz P, Mahajan A, Mahmood K, Maldonado F, Martinez R, Mattingley J, Minnich D, Murgu S, Murillo B, Nason K, Nead M, Parks C, Perret K, Porsch P, Pritchett M, Rickman O, Rosario M, Salio M, Sarkar S, Seevaratnam A, Sethi S, Singh J, Studnicka M, Takubo T, Teba C, Towe C, Trigiani M, Vergnon JR, Viby NE, Wahidi M, Waller E, Wei B, Zanchi D, Zgoda M (2019) Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: one-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol 14(3):445–458
Muñoz-Largacha JA, Litle VR, Fernando HC (2017) Navigation bronchoscopy for diagnosis and small nodule location. J Thorac Dis 9(Suppl 2):S98
Odronic SI, Gildea TR, Chute DJ (2014) Electromagnetic navigation bronchoscopy-guided fine needle aspiration for the diagnosis of lung lesions. Diagn Cytopathol 42(12):1045–1050
Leong S, Shaipanich T, Lam S, Yasufuku K (2013) Diagnostic bronchoscopy-current and future perspectives. J Thorac Dis 5(Suppl 5):S498
Chen AC, Gillespie CT (2018) Robotic endoscopic airway challenge: REACH assessment. Ann Thorac Surg 106(1):293–297
Ost DE, Ernst A, Lei X, Kovitz KL, Benzaquen S, Diaz-Mendoza J, Greenhill S, Toth J, Feller-Kopman D, Puchalski J, Baram D, Karunakara R, Jimenez CA, Filner JJ, Morice RC, Eapen GA, Michaud GC, Estrada-Y-Martin RM, Rafeq S, Grosu HB, Ray C, Gilbert CR, Yarmus LB, Simoff M (2016) Diagnostic yield and complications of bronchoscopy for peripheral lung lesions: results of the AQuIRE registry. Am J Respir Crit Care Med 193(1):68–77
Rojas-Solano JR, Ugalde-Gamboa L, Machuzak M (2018) Robotic bronchoscopy for diagnosis of suspected lung cancer: a feasibility study. J Bronchol Interv Pulmonol 25(3):168–175
Fielding D, Bashirzadeh F, Son JH, Todman M, Tan H, Chin A, Steinke K, Windsor M (2017) First human use of a new robotic-assisted navigation system for small peripheral pulmonary nodules demonstrates good safety profile and high diagnostic yield. Chest 152(4):A858
Swaney PJ, Mahoney AW, Remirez AA, Lamers E, Hartley BI, Feins RH, Alterovitz R, Webster RJ (2015) Tendons, concentric tubes, and a bevel tip: three steerable robots in one transoral lung access system. In: Proceedings—IEEE international conference on robotics and automation, pp 5378–5383
Swaney PJ, Mahoney AW, Hartley BI, Remirez AA, Lamers EP, Feins RH, Alterovitz R, Webster III RJ (2017) Toward transoral peripheral lung access: combining continuum robots and steerable needles. J Med Robot Res 2(1):1750001
Matsuno Y, Asano F, Shindoh J, Abe T, Shiraki A, Ando M, Suzuki T, Seko A, Moriwaki H (2011) CT-guided ultrathin bronchoscopy: bioptic approach and factors in predicting diagnosis. Intern Med 50(19):2143–2148
Szewczyk J, Marchandise E, Flaud P, Royon L, Blanc R (2011) Active catheters for neuroradiology. J Robot Mechatron 23:105–115
Kato T, King F, Takagi K, Hata No (2018) Robotized catheter with enhanced distal targeting for peripheral pulmonary biopsy. IEEE/ASME Trans Mechatron (in review)
Gao Y, Takagi K, Kato T, Hata N (2019) Continuum robot with follow-the-leader motion for endoscopic third ventriculostomy and tumor biopsy. IEEE/Trans Biomedi Eng. https://doi.org/10.1109/TBME.2019.2913752
Montaudon M, Desbarats P, Berger P, De Dietrich G, Marthan R, Laurent F (2007) Assessment of bronchial wall thickness and lumen diameter in human adults using multi-detector computed tomography: comparison with theoretical models. J Anat 211(5):579–588
Choi S, Hoffman EA, Wenzel SE, Castro M, Fain SB, Jarjour NN, Schiebler ML, Chen K, Lin C-L (2015) Quantitative assessment of multiscale structural and functional alterations in asthmatic populations. J Appl Physiol 118(10):1286–1298
Weibel ER (1963) Morphometry of the human lung, chapter geometric and dimensional airway models of conductive, transitory and respiratory zones of the human lung. Springer, New York, pp 136–142
Pulli K, Baksheev A, Kornyakov K, Eruhimov V (2012) Real-time computer vision with opencv. Commun ACM 55(6):61–69
Goldman RE, Bajo A, Simaan N (2014) Compliant motion control for multisegment continuum robots with actuation force sensing. IEEE Trans Robot 30(4):890–902
Palmer D, Cobos-Guzman S, Axinte D (2014) Real-time method for tip following navigation of continuum snake arm robots. Robot Auton Syst 62(10):1478–1485
Neumann M, Burgner-Kahrs J (2016) Considerations for follow-the-leader motion of extensible tendon-driven continuum robots. In: 2016 IEEE international conference on robotics and automation (ICRA). IEEE, pp 917–923
Minami H, Ando Y, Nomura F, Sakai S, Shimokata K (1994) Interbronchoscopist variability in the diagnosis of lung cancer by flexible bronchoscopy. Chest 105(6):1658–1662
Altman DG, Martin Bland J (2005) Standard deviations and standard errors. BMJ 331(7521):903
Funding
This research was funded by Canon U.S.A., Inc.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
KT and FM are employees of Canon U.S.A., Inc. NH has a financial interest in Harmonus, a company developing image guided therapy products. NH’s interests were reviewed and are managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
This article does not contain patient data.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dupourqué, L., Masaki, F., Colson, Y.L. et al. Transbronchial biopsy catheter enhanced by a multisection continuum robot with follow-the-leader motion. Int J CARS 14, 2021–2029 (2019). https://doi.org/10.1007/s11548-019-02017-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11548-019-02017-w