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Flexible Needle Steering with Tethered and Untethered Actuation: Current States, Targeting Errors, Challenges and Opportunities

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Abstract

Accurate needle targeting is critical for many clinical procedures, such as transcutaneous biopsy or radiofrequency ablation of tumors. However, targeting errors may arise, limiting the widespread adoption of these procedures. Advances in flexible needle (FN) steering are emerging to mitigate these errors. This review summarizes the state-of-the-art developments of FNs and addresses possible targeting errors that can be overcome with steering actuation techniques. FN steering techniques can be classified as passive and active. Passive steering directly results from the needle-tissue interaction forces, whereas active steering requires additional forces to be applied at the needle tip, which enhances needle steerability. Therefore, the corresponding targeting errors of most passive FNs and active FNs are between 1 and 2 mm, and less than 1 mm, respectively. However, the diameters of active FNs range from 1.42 to 12 mm, which is larger than the passive steering needle varying from 0.5 to 1.4 mm. Therefore, the development of active FNs is an area of active research. These active FNs can be steered using tethered internal direct actuation or untethered external actuation. Examples of tethered internal direct actuation include tendon-driven, longitudinal segment transmission and concentric tube transmission. Tendon-driven FNs have various structures, and longitudinal segment transmission needles could be adapted to reduce tissue damage. Additionally, concentric tube needles have immediate advantages and clinical applications in natural orifice surgery. Magnetic actuation enables active FN steering with untethered external actuation and facilitates miniaturization. The challenges faced in the fabrication, sensing, and actuation methods of FN are analyzed. Finally, bio-inspired FNs may offer solutions to address the challenges faced in FN active steering mechanisms.

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Acknowledgments

The authors gratefully acknowledge funding support from the National Medical Research Council Clinician Scientist grant (NMRC CSA-MOH-000326), the Hong Kong Research Grants Council (RGC) Collaborative Research Fund (CRF C4026-21GF: 2300075; C4063-18G: 2300056), General Research Fund (GRF Ref. No.: N_CUHK.420/22 and 14216022) and (GRS) #3110167#3110137, the Reserve Leader Funding Project of Leading Talent Echelon of Heilongjiang Province of China (No. 2501050628), and China Scholarship Council under CSC 202108230187.

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Authors and Affiliations

  1. The Key Laboratory of Advanced Manufacturing and Intelligent Technology, Harbin University of Science and Technology, Harbin, China

    Mingyue Lu & Yongde Zhang

  2. The Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore

    Chwee Ming Lim

  3. Duke-NUS Graduate Medical School, Singapore, Singapore

    Mingyue Lu & Chwee Ming Lim

  4. The Department of Electronic Engineering and the Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Hong Kong, China

    Hongliang Ren

  5. The Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore

    Mingyue Lu & Hongliang Ren

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  1. Mingyue Lu
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  2. Yongde Zhang
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Correspondence to Hongliang Ren.

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Lu, M., Zhang, Y., Lim, C.M. et al. Flexible Needle Steering with Tethered and Untethered Actuation: Current States, Targeting Errors, Challenges and Opportunities. Ann Biomed Eng 51, 905–924 (2023). https://doi.org/10.1007/s10439-023-03163-8

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