Laser Guidance Improves Accuracy and First-pass Success in CT-Guided Interventions: A Multicenter Randomized Trial

Freehand computed tomography (CT)-guided percutaneous needle puncture can be inaccurate, especially for small or difficult thoracoabdominal lesions. Automatic gantry-mounted laser navigation projects the planned trajectory onto the patient, offering a low-cost alternative to electromagnetic (EM) or robotic guidance systems.

To determine whether laser guidance improves the accuracy and efficiency of CT-guided punctures compared to the conventional freehand technique.

In this multicenter randomized trial, 170 adults with thoracic or abdominal lesions ≥10mm were assigned to laser-guided intervention (n = 85) or freehand control (n = 85). The primary endpoint was successful lesion access with ≤2 needle repositionings. Secondary endpoints included needle-tip error, number of CT scans, puncture time, and complications.

Baseline characteristics were comparable between groups. Laser guidance increased the successful puncture rate to 91.4% versus 37.3% with freehand (P<.001) and reduced mean targeting error (2.1±0.9 mm vs 3.5±0.8 mm; P<.001). Fewer confirmatory scans were required (4.1±2.1 vs 4.9±2.4; P = .014). Puncture duration was unchanged (18.3±4.1 vs 19.0±5.2 min; P = .45). Major complication rates were low and similar (∼5% in each group, P = 1.00), consisting of pneumothoraces requiring chest tubes in each arm.

Gantry-mounted laser guidance markedly enhances first-pass success and accuracy of CT-guided thoracoabdominal punctures without adding procedure time or risk, providing an efficient, low-cost alternative to the traditional freehand technique.