Development and evaluation of a robotic system for lumbar puncture and epidural steroid injection

INTRODUCTION: Lumbar puncture is an important medical procedure for various diagnostics and therapies, but it can be hazardous due to individual variances in subcutaneous soft tissue, especially in the elderly and obese. Our research describes a novel robot-assisted puncture system that automatically controls and maintains the probe at the target tissue layer through a process of tissue recognition. METHODS: The system comprises a robotic system and a master computer. The robotic system is constructed based on a probe consisting of a pair of concentric electrodes. From the probe, impedance spectroscopy measures bio-impedance signals and transforms them into spectra that are communicated to the master computer. The master computer uses a Bayesian neural network to classify the bio-impedance spectra as corresponding to different soft tissues. By feeding the bio-impedance spectra of unknown tissues into the Bayesian neural network, we can determine their categories. Based on the recognition results, the master computer controls the motion of the robotic system. RESULTS: The proposed system is demonstrated on a realistic phantom made of ex vivo tissues to simulate the spinal environment. The findings indicate that the technology has the potential to increase the precision and security of lumbar punctures and associated procedures. DISCUSSION: In addition to lumbar puncture, the robotic system is suitable for related puncture operations such as discography, radiofrequency ablation, facet joint injection, and epidural steroid injection, as long as the required tissue recognition features are available. These operations can only be carried out once the puncture needle and additional instruments reach the target tissue layer, despite their ensuing processes being distinct.