Automated Robotic Needle Puncture for Percutaneous Dilatational Tracheostomy

2026-02-26

AI Summary

This study addresses the significant risks associated with manual needle insertion during percutaneous dilatational tracheostomy (PDT), where inaccuracies in position and angle can lead to severe complications. To overcome this challenge, the authors present the first robotic system for automated PDT needle insertion, featuring velocity-based control integrated with dual electromagnetic sensors for real-time needle guidance. An adaptive constrained controller is specifically designed to compensate online for kinematic uncertainties and prevent collisions. In simulated human trials involving 400 insertions, the system achieved a median positional error of only 1.7 mm and a midline angular deviation of 4.13°, demonstrating substantially improved accuracy and safety. These results validate the clinical feasibility and innovation of the proposed approach.

Technology Category

• Intelligent Robots: State Estimation
• Natural Language Processing: Safety and Robustness
• Planning, Routing, and Scheduling: Optimization of Spatio-temporal Systems

Application Category

• Responsible Web: Machine-in-the-loop, human agency and autonomy
• Systems and Infrastructure for Web, Mobile and WoT: Energy management for devices in mobile Web and WoT environments
• User Modeling, Personalization and Recommendation: User privacy protection in personalized systems

Abstract

Percutaneous dilatational tracheostomy (PDT) is frequently performed on patients in intensive care units for prolonged mechanical ventilation. The needle puncture, as the most critical step of PDT, could lead to adverse consequences such as major bleeding and posterior tracheal wall perforation if performed inaccurately. Current practices of PDT puncture are all performed manually with no navigation assistance, which leads to large position and angular errors (5 mm and 30 degree). To improve the accuracy and reduce the difficulty of the PDT procedure, we propose a system that automates the needle insertion using a velocity-controlled robotic manipulator. Guided using pose data from two electromagnetic sensors, one at the needle tip and the other inside the trachea, the robotic system uses an adaptive constrained controller to adapt the uncertain kinematic parameters online and avoid collisions with the patient's body and tissues near the target. Simulations were performed to validate the controller's implementation, and then four hundred PDT punctures were performed on a mannequin to evaluate the position and angular accuracy. The absolute median puncture position error was 1.7 mm (IQR: 1.9 mm) and midline deviation was 4.13 degree (IQR: 4.55 degree), measured by the sensor inside the trachea. The small deviations from the nominal puncture in a simulated experimental setup and formal guarantees of collision-free insertions suggest the feasibility of the robotic PDT puncture.

Problem

• Percutaneous Dilatational Tracheostomy
• needle puncture
• position error
• angular error
• surgical accuracy

Innovation

• robotic needle insertion
• adaptive constrained control
• electromagnetic tracking
• percutaneous dilatational tracheostomy
• collision avoidance