Abstract of the Year No. 2: Initial Experience of robotic-Assisted Ablation: A Rapid Learning Curve Leads to Shorter Procedures with Less Needle Repositioning
Presentation: Wednesday, April 2, at 8 a.m.
One institution’s experience utilizing robotic-assisted ablation showed that after a short learning curve, physicians were able to conduct abdominal ablations more quickly and with minimal probe adjustment—as well as navigate complex lesions with ease.
Interventional radiologists at UC San Diego detailed their experience with robotic-assisted ablation in one of SIR 2025’s Abstracts of the Year, collating the results from 39 patients who underwent percutaneous ablation with a robotic device.
Zachary Berman, MD
“Percutaneous ablation has a large role in the treatment of many kinds of malignancies, though it suffers from a lot of issues that have to do with probe and antenna placement," said Zachary Berman, MD, lead author. “These issues have shown promise for improvement by utilizing robotics to not only have more precise probe placement but also to allow for more complex ablations to be performed than what a human can do by hand.”
Robotic-assisted procedures have become commonplace in surgical settings—though according to Dr. Berman, many physicians were reticent to implement it at first because it took longer than doing an open procedure or laparoscopy. However, as physicians grew more facile with the technology, robotic assistance has shown improved outcomes and become the standard of care in surgery. Inspired by this, Dr. Berman wanted to show that a similar learning curve would likely be seen in interventional radiology as well.
Dr. Berman and his team tracked about 50 patients, 39 of whom are detailed in the abstract. They found that after an initial learning curve, procedure time decreased from 40 minutes to 24 minutes, with an average of 33 minutes per procedure.
“There is a learning curve,” Dr. Berman said. “The setup for the procedure is very different. It requires a lot more communication with your technologists and anesthesia staff to ensure everything is set up correctly, so that you can quickly plan a CT scan, which is where most of the work is done.”
Utilizing robotics for precise probe placement and needle trajectory enabled more complex ablation, according to researchers.
In addition, the needle trajectory planning must be done on a separate workstation, which took some time to get comfortable with, Dr. Berman said. However, once the initial setup was complete, researchers found that the probe placement itself went very quickly.
“A lot of the learning experience was being prepared beforehand. Being able to choose your trajectory quickly really helped, and I think what the study shows is that you don’t need thousands of patients to get really facile at this technology,” Dr. Berman said.
The data presented in the abstract document the first 20 and last 20 patients treated in order to showcase the evolution of the team’s skill set and comfort level with the technology. While early cases did require some needle adjustment by hand, or occasionally switching to a manual insertion, the rates of complete manual probe placement were almost eliminated in later patients, and needle repositioning went down.
“Understanding what the robot can do and how it will transition from your CT planning to real life will reduce the amount of probe repositions,” Dr. Berman said. “Minor course corrections may still be required, but getting really close on these difficult lesions is a game changer for a lot of our interventions.”
Though researchers were primarily looking at timing, they found that the efficacy of the robotic assistance was on par with previous reported rates of complete response after treatment.
“I think it’s a testament to the fact that we were using the robotic ablation on amore advanced procedures,” Dr. Berman said. “We were able to achieve standard of care level outcomes despite working in advanced and difficult to reach locations.” According to Dr. Berman, he and his team were able to navigate complex situations such as lesions in the hepatic dome, wherein the tumor is at the top of the liver. In these cases, ultrasound placement is not feasible, so CT guidance is frequently used. However, physicians may have to drop into a patient’s lung to reach the tumor, which may create a pneumothorax.
“With a robot, you can do trajectories that a human could never do, and you don’t have to worry about going through the lung,” Dr. Berman said. “Suddenly, tumors that aren’t ablation candidates—or at least not ablation candidates with conventional techniques—are now no more difficult than any other ablation you would do. This truly opens the door for increased patient access.”
For any IRs considering implementing robotic-assisted ablations in their practice, Dr. Berman urges patience and an open mind.
“Your first procedure will be an ordeal,” he said. “It’s so different from anormal IR workflow, and there will be frustrations. But by your fourth or fifth procedure, it’s going to feel routine, and there will come a point where you will feel like you can’t do this without the robot. Even if your first ablation takes longer, the time will come down as you grow more familiar."
Dr. Berman believes that robotic guidance will be the future of IR therapies—and that once other IRs give it a chance, they’ll agree as well.
“There are plenty of IRs with great hand positioning who can be very precise,” he said. “But as you gain more experience with a robot, you will very quickly realize that this is a dramatic change for the field of IR and likely to be a permanent one that changes the specialty for the better.”
