Robot-Assisted Versus Manual Puncture for Pulmonary Nodule Ablation

Pulmonary nodule ablation has become an important minimally invasive treatment option for patients who are unsuitable for surgical resection or who prefer image-guided local therapy. Successful CT-guided ablation depends on accurate needle placement, which may require repeated CT scans and multiple needle adjustments when conventional manual puncture is used. Robotic navigation systems have the potential to improve puncture precision and procedural efficiency while maintaining procedural safety.

This prospective observational cohort study compares robot-assisted puncture using the TH-S1 robotic navigation system with conventional manual CT-guided puncture in patients undergoing pulmonary nodule ablation. Participants are assigned to treatment groups according to routine clinical practice without randomization.

The primary outcomes are the number of intraoperative CT scans and needle adjustments. Secondary outcomes include puncture success, puncture deviation distance, radiation exposure measured by dose-length product (DLP), and procedure-related complications. Baseline characteristics will be adjusted using propensity score-based weighting methods before comparative analyses.

The study aims to evaluate whether robot-assisted puncture improves procedural efficiency while maintaining comparable safety and technical success relative to conventional manual puncture.

Inclusion criteria

• Age ≥18 years.
• Patients with peripheral pulmonary nodules scheduled for CT-guided thermal ablation.
• Eligible for either robot-assisted or conventional manual puncture according to routine clinical practice.
• Written informed consent provided.

Exclusion criteria

• Pulmonary nodules unsuitable for percutaneous ablation because of proximity to major vessels, bronchi, or other critical structures.
• Previous thoracic surgery or local treatment affecting puncture planning.
• Severe cardiopulmonary dysfunction or other contraindications to CT-guided ablation.
• Pregnancy.
• Inability or unwillingness to provide informed consent.