Needle Steering for Robot-Assisted Insertion into Soft Tissue:A Survey

Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on needle insertion.It is necessary to summarize and analyze the existing results to promote the future development of theories and applications of needle insertion.Thus,a survey of the state of the art of research is presented on algorithms of needle steering techniques,the surgical robots and devices.Based on the analysis of the needle insertion procedure,the concept of needle steering is defined as a kinematics problem,which is to place the needle at the target and avoid the obstacles.The needle steering techniques,including the artificial potential field method and the nonholonomic model,are introduced to control the needles for improving the accuracy.Based on the quasi-static thinking,the virtual spring model and the cantilever-beam model are developed to calculate the amount of needle deflection and generate the needle path.The phantoms instead of the real tissue are used to verify the models mentioned in most of the experimentations.For the desired needle trajectories,the image-guided robotic devices and some novel needles are presented to achieve the needle steering.Finally,the challenges are provided involving the controllability of the long flexible needle and the properties of soft tissue.The results and investigations can be used for further study on the precision and accuracy of needle insertion.

Comparison of Gluteal Muscle Intramuscular Injection Sites of Japanese Healthy Subjects: Considerations for Optimal Insertion of Injection Needle Length

Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the “Distance from the Epidermis to the Under-Fascia (DEUF)” and “Distance from the Epidermis to the Iliac Bone (DEB)” of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch’s one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark’s point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter’s point (P < 0.01) at ventrogluteal site on the right side, and Clark’s point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks Hochstetter’s point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.

Force modeling for needle insertion into soft tissue based on mechanical properties and geometric parameters

The force model during needle insertion into soft tissue is important for accurate percutaneous intervention.In this paper,a force model for needle insertion into a tissue- equivalent material is presented and a series of experiments are conducted to acquire data from needle soft- tissue interaction process.In order to build a more accurate insertion force model,the interaction force between a surgical needle and soft tissue is divided into three parts:stiffness force,friction force,and cutting force.The stiffness force is modeled on the basis of contact mechanics model.The friction force model is presented using a modified Winkler' s foundation model.The cutting force is viewed as a constant depending on a given tissue.The proposed models in the paper are established on the basis of the mechanical properties and geometric parameters of the needle and soft tissue.The experimental results illustrate that the force models are capable of predicting the needle-tissue interaction force.The force models of needle insertion can provide real-time haptic feedback for robot-assisted procedures,thereby improving the accuracy and safety of surgery.

Fuzzy control method to minimize the needle deflection during needle insertion therapy

A fuzzy control algorithm is adopted to help the needle hit the target more accurately. The experimental setup for the needle insertion is built up to validate the algorithm. How the forces dur- ing the insertion make the needle deflect away from the planned path is given, and the normal meth- od correcting the deflection is obtained accordingly. Because the normal method cannot perform well for correction, a fuzzy controller is established. The input module, output module, fuzzification module, defuzzification module and inference engine for the controller are given respectively accord- ing to the fuzzy theory. Our experimental results show that the fuzzy controlling system presenting in the paper can better eliminate the deflection.

Method with repeated extraction-insertion cycles to im prove the needle insertion accuracy

In order to improve the effectiveness of percutaneous diagnosis and therapies, the needle insertion into the deforming soft and inhomogenous tissue should be accurate. In this study a needle with 6 degrees of freedom force/torque sensor is used to find the relationship between the pathway＇s length and the force. Our experiments show that the method with repeated extraction-insertion cy- cles can make the needle approach the target as much as possible. Meanwhile a method to obtain the appropriaterepeated extraction-insertion cycles is given to drive the needle to execute the repeat- ed cycles efficiently. Experiments and discussions were conducted to preliminarily validate the meth- od.

Sensitivity of Influential Factors on Needle Insertion Experiments:A Quantitative Analysis on Phantom Deformations and Needle Deflections

High repeatability of needle insertion experiments is essential to the needle-phantom interaction model validation.However,the influential factors governing the accuracy of the phantom and needle deformations have not been systematically studied.In this paper,the impact of influential factors,including phantom characteristic represented by the ratio of DMSO and thawing time(TT),needle properties represented by needle external diameter(NED)and operating factors such as needle insertion velocity(IV),insertion positions(IP)and repeated insertion times(RITs)are analyzed by orthogonal experiment design.The range calculation shows the most sensitive parameters to phantom deformations are RITs,IV and DMSO while the most sensitive parameters to needle deflection are DMSO,TT and NED.By variance analysis,the significant factors on maximum tissue deformation(MTD)are IV,followed by RITs,DMSO and IP.And NED and TT have nearly no significant impact on MTD.The significant sequence on maximum needle deflection(MND)is as follows:DMSO,TT and NED.Results show that,among all impacting factors,phantom deformation is susceptible to both material properties and operative factors while the needle deflection is more susceptible to material properties of the phantom,which can help researchers in related fields to conduct experiments in a more precise manner and better understand the needle-phantom interaction mechanism.

Soft Tissue Deformation Modeling in the Procedure of Needle Insertion:A Kriging‑Based Method

The simulation and planning system(SPS)requires accurate and real-time feedback regarding the deformation of soft tissues during the needle insertion procedure.Traditional mechanical-based models such as the finite element method(FEM)are widely used to compute the deformations of soft tissue.However,it is difficult for the FEM or other methods to find a balance between an acceptable image fidelity and real-time deformation feedback due to their complex material properties,geometries and interaction mechanisms.In this paper,a Kriging-based method is applied to model the soft tissue deformation to strike a balance between the accuracy and efficiency of deformation feedback.Four combinations of regression and correlation functions are compared regarding their ability to predict the maximum deformations of ten characteristic markers at a fixed insertion depth.The results suggest that a first order regression function with Gaussian correlation functions can best fit the results of the ground truth.The functional response of the Kriging-based method is utilized to model the dynamic deformations of markers at a series of needle insertion depths.The feasibility of the method is verified by investigating the adaptation to step variations.Compared with the ground truth of the finite element(FE)results,the maximum residual is less than 0.92 mm in the Y direction and 0.31 mm in the X direction.The results suggest that the Kriging metamodel provides real-time deformation feedback for a target and an obstacle to a SPS.

Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI)

Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.

Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.

Differential Insertion Depths of Filiform Needle, Concept and Application

In this paper, the background, evolution, basic meaning, clinical application and the detail operating procedures of the differential insertion depth in filiform needle acupuncture were discussed based on the classical expositions of the Yellow Emperor’s Canon of Medicine. It is believed that the differential insertion depth reflects the basic idea of expelling the evil Qi from the body in the application of traditional acupuncture. Since the site of evil invasion has different shades, the position of evil Qi and correct differentiation has become the operation key points of needle insertion. Apart from this, the Yellow Emperor’s Canon of Medicine has further associated the clinical application of filiform needle insertion depth with the seasonal change of Yin and Yang, the body built of the patients, the nature of the diseases, the heat or cold pathogenic factors of the illness, the excess and deficiency of the patient, and the reinforcing and reducing function of acupuncture. These elaborations have greatly enriched the basic content of acupuncture and laid a systematic theoretical foundation of filiform needle operation. The differential insertion depth in acupuncture has its specific meaning, the emphasis of insertion depth of filiform needle with its differentiated clinical implication exemplifies the perceptual thinking features of traditional acupuncture and typical reveals the uniqueness of Chinese civilization.

Important Issues of Needle Insertion into Soft Tissue

Needle insertion procedures have been gaining in popularity with medical communities and patients over the recent years.Currently,their applications span a wide range of diagnostic and therapeutic procedures and there is still a growing tenden?cy toward integrating needle insertion into other procedures and surgeries.Its less invasive nature,which is performed locally on the body,largely explains this growing trend.This results in less intraoperative tissue damage and shorter post-operative recovery time.Many procedures like biopsy,deep brain stimulation,and cancer treatments are done using needles/eatheters.However,despite all the advantages of needle insertion procedures,the inherent complications resulting from them,such as tissue deformation,needle deflection,tissue inhomogeneity,patient variability,and associated uncertainty,can hardly be missed.Therefore,a needle insertion procedure requires that we address promising aspects and associated concerns.Against this backdrop,this paper provides a review of some of the main issues associated with a generic needle insertion procedure.

THEORETICAL ANALYSIS ON THE DEPTH OF NEEDLE-INSERTION

In the present paper, the author sums up and analyzes descriptions about needle-insertion depth in Chinese classical medical book Huang Di Nei Jing (《黄帝内经》The Yellow Emperor’s Internal Classic). In many chapters of Nei Jing, the needle-insertion depth is stressed to be various according to 1) the deficiency or excess of syndromes, 2) the patients’ constitution, 3) the severity of disease, 4) the duration of disease, 5) the location of disease, 6) the patient’s age, 7) the location of the needled acupoint, 8) the season, 9) the patient’s temperament, 10) the pulse condition, 11) the state of “Deqi”, and 12) the location of the running course of meridians. In addition, different kinds of diseases and different stages of diseases also need different depths of needle insertion, different manipulating skills and different stimulating quantity.

单边双针双线摆动缝合轨迹设计及实验验证

针对单边双针双线缝合头插刺机构无法缝制3 mm以上厚度预制体的问题,提出一种不对称的8字形运动轨迹并对插刺机构的运动轨迹进行了设计。首先,基于单边双针双线缝合工艺对插刺机构运动学进行分析,确定摆动插刺机构各构件的尺寸;其次,在ADAMS中构建机构模型并进行轨迹分析;最后,通过实验样机进行缝合实验。实验结果表明,设计的缝合机构可将实际缝合厚度不足3 mm提高到8 mm,并在缝合过程中形成稳定线环,验证了不对称8字形缝合工艺及摆动插刺机构的可靠性。

安全型无损伤针二步结构式垂直固定法在输液港插针中的应用

目的:探讨安全型无损伤针二步结构式垂直固定法在输液港插针中的应用效果。方法:采用便利抽样法,选取南京市某三级甲等医院130例应用输液港的病人,按入院时间进行分组,2021年1月—3月入院的65例应用输液港病人作为对照组,采用常规固定方式进行插针;2021年4月—5月入院的65例应用输液港病人作为试验组,采用安全型无损伤针二步结构式垂直固定法进行插针。比较两组病人一次插针成功率、垂直插针率、穿刺时疼痛评分和插针用时等。结果:试验组一次插针成功率(96.92%)高于对照组(76.92%);试验组垂直插针率(95.38%)高于对照组(66.15%),差异均有统计学意义(P<0.05)。试验组疼痛评分[(1.26±0.44)分]低于对照组[(1.58±0.68)分],差异有统计学意义(P<0.05)。两组插针用时比较,差异无统计学意义(P>0.05)。结论:安全型无损伤针二步结构式垂直固定法能提高输液港一次插针成功率及垂直插针率,降低病人疼痛程度。

骨折断端逆行穿针复位术对锁骨中段粉碎骨折的疗效研究

目的探讨骨折断端逆行穿针复位技术治疗锁骨中段粉碎骨折的临床疗效。方法选取2018年1月至2021年10月收治的锁骨中段粉碎骨折患者46例,随机分为常规组和穿针组,每组23例。常规组行常规复位技术复位骨折,穿针组采用骨折断端逆行穿针复位技术进行复位。记录比较2组手术时间、出血量、切口总长度、并发症发生情况,术后第1天、第1个月、第3个月采用疼痛视觉模拟评分法(VAS)评价肩部疼痛;术后1、3、12个月使用Constant-Murley肩关节功能评分评价肩关节功能。结果穿针组与常规组比较手术时间更短、术中出血量更少、手术切口更短,差异均有统计学意义(P<0.05)。常规组术后发生骨折不愈合、切口愈合不良、臂丛神经损伤并发症要高于穿针组(P<0.05)。所有患者均有随访,随访时间13~15个月。穿针组患者术后1、3、12个月的Constant-Murley肩关节功能评分高于常规组(P<0.05)。穿针组术后1 d、1个月,3个月的VAS评分均低于常规组(P<0.05)。结论与常规复位技术比较,骨折断端逆行穿针复位技术治疗锁骨中段粉碎骨折手术时间更短,手术创伤更小,并发症更少,术后功能恢复更好。

陈全新运用“岭南陈氏针法”治疗围绝经期睡眠障碍经验

介绍陈全新教授运用其祖传的“岭南陈氏针法”治疗围绝经期睡眠障碍的特色经验。对该病的认识,陈教授主张在辨病辨证的基础上辨体辨期,即从疾病、证候、体质及围绝经期气血阴阳消长、脏腑功能特点等方面认识和分析病情。陈教授崇尚华佗“针灸不过数处”的学术思想,强调谨察病机,取穴精准,并注意取穴的左右交替。施术时使用“陈氏飞针法”无痛进针,同时配合特有的行针导气及分级补泻手法,重视针感传导和气至病所,疗效确切。

巨骨穴长针斜刺技术结合苍龟探穴法对肩峰下疼痛综合征临床观察

目的探讨巨骨穴长针斜刺技术结合苍龟探穴法对肩峰下疼痛综合征的治疗效果。方法选取2021年7月至2022年7月本院收治的肩峰下疼痛综合征患者64例,随机分为对照组及观察组,各32例。对照组采用常规针刺治疗,观察组在对照组基础上采用巨骨穴长针斜刺技术结合苍龟探穴法,记录各组治疗前后的视觉模拟量表(VAS)评分、Constant-Murley评分及Barthel指数(BI)评分。结果治疗后,两组患者VAS评分均较前降低(P<0.05),Constant-Murley评分均较前明显提高(P<0.05),BL评分均较治疗前升高(P<0.05);且观察组患者治疗后的VAS评分、Constant-Murley评分、BL评分均优于对照组(P<0.05)。结论巨骨穴长针斜刺技术结合苍龟探穴法可有效提高肩峰下疼痛综合征的针刺治疗效果,促进肩部功能恢复,具有一定应用价值。

1000 CASES OF MUMPS TREATED WITH EAR NEEDLING ON PINGJIAN POINT (MA-T2)

Since 1968,we have treated over 1000 casesof infantile mumps with ear needling on Pingjianpoint(MA-T2)with satisfactory result.The re-port is as follows.