Overview
Workflow Features Benefits
 
 
 
 
RFA OF LIVER TUMOR
TATA MEMORIAL HOSPITAL, INDIA
Heterogeneous large volume Liver lesion ablated using RFA probe in sequential manner.
MAXIO’s planning software displays segmented organs, tumors and vascular structure for effective planning
 
IRREVERSIBLE ELECTROPORATION (IRE) OF LIVER TUMOR
ALFRED HOSPITALS, AUSTRALIA
MAXIO helps clinicians to plan multiple needles in parallel to each other. Robotic positioner would help to execute this complex plan very precisely.
 
CRYO ABLATION OF HCC IN SEGMENT 4
UMMC, MALAYSIA
1.2 cm recurrent HCC in segment IV of the liver was posted for Cryoablation. Using the Robotic positioner, the trajectory and depth of the cryo-probe placement was determined. A 13G cryo-needle (Endocare, Austin, Tx) was then placed in the segment IV lesion using the robotic arm with the patient in suspended expiration. The probe was accurately positioned at the desired location in a single attempt.
 
Radio Frequency Ablation of 12 mm Mass in Liver
RFA of 12 mm mass at 5th segment of the liver
followed by alcohol ablation
Challenge:
Ablation area cannot be predicted easily due to its position in the liver segment.
Procedure:
MAXIO helps to visualize the ablation zone, so it can be adjusted to treat the tumor precisely. The site of lesion is well within the ablation zone in post RFA CT.
Orbital angle : 45.6°
Depth : 64.5 mm
Needle used : 17G
Cooltip : 100-30
Number of needles : one
Planning time : 5 min
Procedure time : 22 min
 
Radio Frequency Ablation of 2 cm of HCC
Patient planned at for radiofrequency ablation
at 7th segment of liver
Challenge:
Lesion is situated posteriorly so planning and treatment is done in posterior position.
Procedure:
2 cm lesion was targeted under GA in prone position. The thermal simulation area covered the lesion.
Orbital angle : 19.46°
Depth : 76.28 mm
Needle used : 17G
Cooltip : 150-30
Number of needles : one
Planning time : 10 min
Procedure time : 30 min
 
Radio Frequency Ablation of Liver lesion with multiple probes
A patient is planned for Radio-frequency ablation
with sequential probe placement
Challenge:
A tumor requiring multiple probe placements to target the lesion completely. Overlapping the ablation zone is a challenge to avoid the residual tumors.
Procedure:
The lesion is ablated in 5 sitting of ablation and three probes placed simultaneous and other 3 probes placed sequential
Orbital angle : 7.85°
Depth : 93.83 mm
Needle used : 17G
Cooltip : 150-40
Planning time : 15 min
Procedure time : 80 min
 
Radio Frequency Ablation 1.8 cm HCC
A patient is planned for radiofrequency ablation
of 5th segment of 1.8 cm lesion
Challenge:
A deep seated lesion requiring the short and safe trajectory.
Procedure:
1.8 cm lesion is targeted with cooltip probe.
Orbital angle : 23.17
CC angle : 0.97°
Depth : 118 mm
Needle used : 17G
Cooltip : 150-30
Number of needles : 1
Planning time : 9 min
Procedure time : 30 min
 
Radio Frequency Ablation of 4 cm HCC
A patient is planned for radiofrequency ablation
of 5th segment of 1.4 cm lesion
Challenge:
Completely covering the tumour with safety margin by thermal ablation zone in sequential probe placements.
Procedure:
The lesion is ablated in two sitting of ablation. Two needles placed in simultaneous and first sitting of ablation done and third needle placed towards caudal border by manipulation and second sitting of ablation done.
Orbital angle : 47.08
CC angle : 0°
Depth : 140 mm
Needle used : 17G
Cooltip : 200-30
Number of needles : 2
Planning time : 9 min
Procedure time : 45 min
 
Radio Frequency Ablation of a HCC and a Lung Lesion
A patient planned for RFA of 25 mm mass at 6th segment of the liver, 9 mm mass at right lung in same procedure
Challenge:
Planning safe and short trajectories with Robotic positioner to cause minimal patient discomfort and
procedure related complications is a challenge with liver and lung ablations together.
Procedure:
The lesion is ablated in two sitting of ablation. Two needles placed in sequential and first sitting of ablation done in liver tumor. Second sitting of ablation done in
lung tumour.
Liver plan:
Orbital angle : -16.05
CC angle : 0°
Depth : 93 mm
Lung Plan :
Orbital angle : -61.84
CC angle : 0°
Depth : - 74.42 mm
Needle used : 17G
Cooltip : 150-30
Planning time : 10 min
Procedure time : 40 m
 
 
Radio Frequency Ablation of 1.5 cm HCC
A patient planned for a radiofrequency ablation
of 1.5 cm lesion in 3rd segment of liver
Challenge:
Avoiding the No Go region like stomach in planning and targeting is a challenge.
Procedure:
RFA done under GA.
Cooltip : 150/30
Orbital angle : 9.56°
CC angle : 6.88°
Depth : 100.23 mm
Planning time : 5 min
Procedure time : 15 min
 
Radio Frequency ablation of recurrent HCC after TACE
A patient was planned for radiofrequency ablation of 3.8*3.7 cm lesion at segment 8 of liver
Challenge:
Post TACE lesion was not visible on Ultrasound and was below diaphragm.
Procedure:
Patient was planned under GA, coolitip: 17G 150/30 Two probes were used.
Orbital angle : 64/63°
CC angle : 18/13°
Depth : 90.9 / 91 mm
Procedure time : 28 min
 
Radio Frequency Ablation of Multiple Liver Lesions
Patient planned for RFA of mulitple lesions in the liver
Challenge:
Lesions are situated close to diaphragm and bowel. Critical organs like lung, vasculature and bowel surround the targets. In free hand, it is difficult to place the probe in target(s) without traumatizing the critical organs.
Procedure:
MAXIO assisted in the precise planning &
targeting of the deep-seated lesions through
safe trajectory with a combination of both
Cranio-caudal and orbital angles.
 
Radio Frequency Ablation of Segment 5 HCC
Patient planned for RFA of (HCC) at Segment 5,
with liver cirrhosis and fluid around liver, with cooltip
Challenge:
It is a tough case because the lesion, to be targeted, is bouncing due to cirrhosis and fluid around liver.
Procedure:
2 cms HCC targeted for RFA with MAXIO at segment 5 of the liver and RFA performed. Trauma to the bowel was avoided by adjusting thermal simulation option. Tip
of the temperature achieved 70° C. Post ablation scan shows, a wedge-shaped area without enhancement covering lesion.
Lesion size : 1.6 x 2 x1.3 cms
Orbital angle : 44°
Depth : 69 mm
Needle used : 17 G/100 mm,
Cooltip : 100-30
Number of needles : 1
Planning time : 10 min
Procedure time : 25 min
 
Radio Frequency Ablation of Liver
Patient planned for RFA of 3 cm HCC mass
Challenge:
Lateral approach requires precise trajectory to target the mass in liver
Procedure:
MAXIO assisted in precise targeting of the lesion on lateral position. No post procedure complications.
Orbital angle : 86.5°
Depth : 68.68 mm
Needle used : Starburst 100 mm
Number of needles : 1
Planning to needle : 10 min
placement
 
Radio Frequency Ablation of Liver Tumor
Heterogeneous large volume Liver lesion ablated using RFA probe in sequential manner. MAXIO’s planning software displays segmented
organs, tumors and vascular structure for effective planning
 
Volumetric Planning & Robotic Assistance for an “AO” Ablation Strategy
“Solutions like MAXIO will help Interventional Oncologists to plan and achieve AO ablation which is as important as RO resection in surgery.”
3D visualization of tumor and vasculature with MAXIO’s intuitive planning
 
Planning of Multiple Liver Lesions for Ablation
MAXIO allows to segment and visualize multiple liver lesions in addition to checking the respective ablation volumes. MAXIO’s intuitive planning helps in volumetric assessment of liver and ablated area
Segmentation of multiple liver lesions
 
Ablation Planning In 3D Anatomical View
MAXIO helps to plan safest probe trajectory. This helps to minimize damage to surrounding structures.
Probe planning in MPR or in 3D view
 
IRE on Iliac Bone
IRE with Nano Knife performed on solitary metastasis right iliac wing from Ca. Prostate
Challenge:
Placing two parallel probes with in a narrow space of 8 mm is very difficult and time consuming, requiring repeated check scans and needle manipulations.
Procedure:
8 mm lesion at iliac bone precisely and quickly targeted with MAXIO for two IRE parallel probe. IRE performed by Nano knife with maximum 3k voltage and 12-15 Amps current. Patient discharged on same day
(Advantage of CT guided intervention).
Orbital angle : 39°
Depth : 69 mm
Needle used : 11G/100 mm
Nanoknife : 150/40
Number of needles : 2
Planning time : 10 min
Procedure time : 60 min
 
Exophytic renal mass Biopsy
Procedure:
1.2 cm left renal mass was targeted with 5° orbital angle at depth of 108 mm. Precise targeting helped to avoid any complications.
 
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