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Marco van Strijen is an interventional radiologist at St Antonius Ziekenhuis (Nieuwegein, The Netherlands) who specialises in non-vascular interventions and interventional oncology. Image-guided procedures feature heavily in his practice, Van Strijen tells Interventional News, enabling him to “[draw] needle paths, [define] targets and [introduce] needles”. Micromate (Interventional Systems) provides robotic assistance for these tasks, Van Strijen reports, detailing how “it is three years that we have been using Micromate”, following on from a successful stint with the early prototype that “functioned so well” that “the rest was history”.
On how Micromate fulfils its role within his practice, Van Strijen begins by acknowledging that for any percutaneous biopsy “it is very important to have a stable needle”, and therefore, “a device that helps you keep the needle stable while advancing the device through the skin to the desired target,” such as Micromate does, is valuable. “This is especially true in […] areas where there is not that much overlying skin or soft tissue [to] hold your needle while you are trying to centre it in the direction of your target,” Van Strijen adds, before exemplifying how unwieldy some of the former approaches to intraprocedural needle stabilisation were: “we were using our own hands, sterile towels draped around the needle insertion point, or sterile forceps, making adjustments until we had the needle in a holding position, but these were not that stable, especially when you have a patient who is still breathing or maybe even starts to move because of their discomfort on the table: you always have the risk of dislodging the needle.”
Van Strijen then enumerates the precise advantages of having a completely stable needle, as achieved with Micromate—“not only will it help in reducing the number of [needle] re-positionings, but it reduces the need for imaging, as you can advance the needle as quickly as possible. And this is [of…] benefit in reducing the amount of radiation, not only for the patient but also for yourself as the operator.” Furthermore, Van Strijen speaks of the procedural time reduction that this results in, and, consequently, the discomfort the patient is subjected to on the table.
In a particular case of Van Strijen’s—that of a percutaneous lung biopsy close to the pleura in a 52-year-old patient referred with suspected rectal carcinoma—in which Micromate was used under live imaging, the procedure time was 43% faster than previously reported, Interventional Systems states. The radiation level decrease measured 70%. Greater needle stability facilitates greater procedural accuracy, which, Van Strijen shares, makes “[working] in areas that rely on needles being positioned to millimetre or sub-millimetre accuracy” possible. For example, this could be “in the vicinity of critical structures such as the neck or the face or close to the major vessels of the thorax”. Van Strijen asserts that “this is where this type of robotic device comes in very handy.”
To the question posed by Interventional News of how Micromate reduces complications in lung biopsy cases, such as the aforementioned, Van Strijen states that “a quick in-and-out is the ideal strategy”, and with Micromate, the biopsy is possible “during one single breath-hold”. The incidence of pneumothoraces, which Van Strijen notes is the “most encountered complication in this procedure”, is “[reduced] significantly” by virtue of being able to avoid unnecessary pleura punctures. Where the needle is less stable, the necessary multiple attempts and sometimes, leaving the needle in, can cause tears in the pleura, Van Strijen explains.
Micromate may be responsible for something akin to his team becoming victims of their own success, Van Strijen then admits—”I think that by having this type of technology available, we are challenged quite a bit by our referring clinicians who are asking for more and more challenging lesions to be biopsied.” In practice this means “trying to get histology from a lesion of just a few millimetres,” in contrast to a decade ago, when, Van Strijen says “a two- or three-centimetre lesion was common”.
Likewise, because of the development of robotic technology, Van Strijen now carries out biopsies “next to very challenging structures—close to major vessels, close to the beating heart”.
Van Strijen is also keen to mention a further advantage of Micromate and the impact it has in his teaching hospital. “This type of device should be very easy to use, one that any user immediately understands without a lot of training—after only one or two demo cases,” he opines. And, with Micromate satisfying such an expectation, Van Strijen sees it as “[bridging] the gap between inexperienced and experienced users […] Young doctors are challenged in trying to perform the same procedures as their tutors,” but, as Van Strijen informs Interventional News, “one of the things I find very helpful [about Micromate]” is how doctors of different levels of experience can use it successfully.”
