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Stereotactic and robotic guidance has been gaining popularity for liver ablation, although has not been established in lung ablation. The purpose of this study is to determine the feasibility, safety, and accuracy of robotic RFA for pulmonary metastases, and compare procedures with a conventional freehand cohort.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A single center study with prospective robotic cohort, and retrospective freehand cohort. RFA was performed under general anesthesia using high frequency jet ventilation and CT guidance. Main outcomes were (i) feasibility\/technical success (ii) safety using Common Terminology Criteria for Adverse Events (iii) targeting accuracy (iv) number of needle manipulations for satisfactory ablation. Robotic and freehand cohorts were compared using Mann\u2013Whitney <jats:italic>U<\/jats:italic> tests for continuous variables, and Fisher\u2019s exact for categorical variables.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Thirty-nine patients (mean age 65\u2009\u00b1\u200913\u00a0years, 20 men) underwent ablation of 44 pulmonary metastases at single specialist cancer center between July 2019 and August 2022. 20 consecutive participants underwent robotic ablation, and 20 consecutive patients underwent freehand ablation. All 20\/20 (100%) robotic procedures were technically successful, and none were converted to freehand procedures. There were 6\/20 (30%) adverse events in the robotic cohort, and 15\/20 (75%) in the freehand cohort (<jats:italic>P<\/jats:italic>\u2009=\u20090.01). Robotic placement was highly accurate with 6\u00a0mm tip-to-target distance (range 0\u201314\u00a0mm) despite out-of-plane approaches, with fewer manipulations than freehand placement (median 0 vs. 4.5 manipulations, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 and 7\/22, 32% vs. 22\/22, 100%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Robotic radiofrequency ablation of pulmonary metastases with general anesthesia and high frequency jet ventilation is feasible and safe. Targeting accuracy is high, and fewer needle\/electrode manipulations are required to achieve a satisfactory position for ablation than freehand placement, with early indications of reduced complications.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11548-023-02895-1","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T16:03:03Z","timestamp":1681833783000},"page":"1819-1828","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Robotic versus freehand CT-guided radiofrequency ablation of pulmonary metastases: a comparative cohort study"],"prefix":"10.1007","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8504-2968","authenticated-orcid":false,"given":"Edward W.","family":"Johnston","sequence":"first","affiliation":[]},{"given":"Jodie","family":"Basso","sequence":"additional","affiliation":[]},{"given":"Francisca","family":"Silva","sequence":"additional","affiliation":[]},{"given":"Arafat","family":"Haris","sequence":"additional","affiliation":[]},{"given":"Robin L.","family":"Jones","sequence":"additional","affiliation":[]},{"given":"Nasir","family":"Khan","sequence":"additional","affiliation":[]},{"given":"Helen","family":"Lawrence","sequence":"additional","affiliation":[]},{"given":"Jakob","family":"Mathiszig-Lee","sequence":"additional","affiliation":[]},{"given":"James","family":"McCall","sequence":"additional","affiliation":[]},{"given":"David C.","family":"Cunningham","sequence":"additional","affiliation":[]},{"given":"Nicos","family":"Fotiadis","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"2895_CR1","doi-asserted-by":"publisher","first-page":"908","DOI":"10.3390\/cancers13040908","volume":"13","author":"A Delpla","year":"2021","unstructured":"Delpla A, de Baere T, Varin E, Deschamps F, Roux C, Tselikas L (2021) Role of thermal ablation in colorectal cancer lung metastases. 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Edward Johnston has received funding for travel and accommodation to ablation conferences from Boston Scientific and MIM software. The rest of the authors declare no conflicts of interest, and declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Royal Marsden Hospital Institutional Review Board (code SE1062).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed written consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}