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.