Ultrasound-Led Multimodality Imaging-Guided Robotic Needle Insertion With Respiratory Phase Consistency in Phantom and Animal Models.

OBJECTIVE: To evaluate the puncture accuracy and feasibility of TONGMAI, an electromagnetic-tracking-based, ultrasound (US)-led multimodality imaging-guided robotic system using consistency-aware respiratory-guided cognitive fusion, in phantom and animal models. METHODS: Three experienced and six inexperienced physicians performed needle insertion in static phantom, respiratory phantom, New Zealand white rabbit liver and Guangxi Bama miniature-pig liver experiments using robot assistance, freehand puncture or needle-guide assistance. The primary outcome was real-time US-based puncture accuracy (US-Error). Exploratory robot-assisted punctures of non-hepatic targets (spleen, kidney, pancreas, gallbladder, bladder and lung) in miniature pigs were evaluated for first-attempt success, needle redirection, US-Error when applicable and complications. RESULTS: Among experienced physicians, US-Error did not differ significantly among robot assistance, freehand puncture and needle-guide assistance in static phantom, respiratory phantom, rabbit liver or miniature-pig liver experiments (overall p = 0.115, 0.131, 0.124 and 0.397, respectively). With robot assistance, mean US-Error values were 0.35, 0.57, 1.28 and 1.32 mm, respectively. Among inexperienced physicians, robot assistance reduced US-Error versus freehand puncture or needle-guide assistance in both phantom settings and versus freehand puncture in rabbit and miniature-pig liver experiments (p = 0.003 and p = 0.002, respectively). Under robot assistance, US-Error did not differ significantly between experienced and inexperienced physicians across all settings (p = 0.110, 0.054, 0.818 and 0.548, respectively). In exploratory non-hepatic punctures, first-attempt success varied by target, with no procedure-related complications. CONCLUSION: TONGMAI supported consistent puncture performance in experienced physicians and improved accuracy in inexperienced physicians under phantom and animal conditions, supporting further development of a US-led multimodality robotic workflow for deformable thoracoabdominal targets.