Robot-Assisted Microwave Ablations of Liver Tumors: Is This the Beginning of a Paradigm Shift?

To evaluate the safety and accuracy of robot-assisted microwave ablation (MWA) for primary and secondary liver tumors using the Epione (Quantum Surgical, Montpellier, France) robotic system.

This single-center retrospective study included all computed tomography (CT)-guided robotic MWA procedures performed at the Miami Cancer Institute, Baptist Health South Florida from May 2023 to March 2025. Primary endpoints were safety, assessed by adverse events related to robotic guidance or ablation, and accuracy, defined by the need for minor (depth/lateral) or major (antenna removal and reinsertion) adjustments. Secondary endpoints included feasibility, technical success, local tumor progression (LTP), LTP-free survival (LTPFS), and local control (LC).

A total of 153 robot-assisted antenna placements were performed to treat 152 tumors in 78 patients. Robotic placement was feasible in 98.7% (77/78) of patients. Technical success was achieved in 96.8% (152/157) of trajectories. Among all trajectories, 18.5% (29/157) required no adjustment, 62.4% (98/157) required minor depth adjustment, 17.8% (28/157) required minor lateral adjustment, and 3.2% (5/157) required major adjustment. Of major adjustments, 4 were corrected with robotic reinsertion, and 1 was corrected manually. Mean preadjustment lateral deviation was 5.6 mm (SD ±3.9). Adverse events occurred in 14.1% (11 Grade 1, 2 Grade 2, and 1 Grade 3) of procedures, none directly related to robotic guidance. Median follow-up was 6.9 months. The 6-month LTPFS per tumor for patients treated in the first versus second year was 87.1% versus 94.9%, respectively (hazard ratio, 0.385; 95% confidence interval, 0.083-1.771; P = .220).

Robotic guidance for liver MWA demonstrated high feasibility, excellent technical success, and low placement error with no robot-related complications, supporting its safety and accuracy in clinical practice.