Robotics are not new to needle biopsy procedures. Using a joy stick to deftly manipulate a robotic arm under X-ray guidance, surgeons have been able to obtain tissue specimens they often miss in conventional biopsy techniques. That works fine for fixed organs like the prostate or spine, but target a tiny tumor deep inside a moving organ like the kidney and it's like trying to thread a needle, blindfolded. "You image the kidney and say, Put the needle here," says endourologist Thomas Jarrett, "and by the time the robotic arm carries out the task, the organ may have moved." No more. By linking a robotic device developed at Hopkins with real-time CT imaging, Jarrett and other surgeons are able to do a biopsy on the smallest lesions in a moving organ. That's because the device, called PAKY, or percutaneous access to the kidney, is able to lock on a moving target, much like a laser-guided missile. "The robotic arm moves with the kidney, following the tumor no matter where it goes," Jarrett says. "It makes sense that if you can deliver your needle more accurately, you'll have better sensitivity and better results." And that means more accurate staging of the tumor and the most appropriate treatment plan for the patient. Also, patients experience less bleeding with this biopsy approach, and less risk of injury to adjacent organs. While PAKY is currently limited to use in biopsies, in the future it may be used in ablative therapies to destroy cancer cells, or even in high-dose radiation therapies.
-Gary Logan
Hopkins Medical News, Spring 2003
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