Laser Guidance Boosts CT-Guided Puncture Success in Trial

Key Takeaways

• Laser guidance was associated with higher successful lesion access than freehand technique during CT-guided thoracic or abdominal puncture.
• Laser guidance was associated with lower targeting error and fewer confirmatory scans during lesion access.
• Puncture duration was similar, and major complication rates remained low in both groups, with pneumothoraces requiring chest tubes reported in each arm.

In a multicenter randomized trial of adults with thoracic or abdominal lesions 10 mm or larger, gantry-mounted laser guidance achieved successful puncture in 91.4% versus 37.3% with freehand technique. The comparison across multiple centers focused on whether operators could reach the target with limited needle adjustment. Secondary measures included targeting accuracy, scan use, procedure timing, and major complications. The findings showed a clear technical-performance difference during CT-guided thoracoabdominal puncture in adults.

The study randomized 170 adults in a 1:1 ratio to laser-guided intervention or freehand control for thoracic or abdominal lesions measuring at least 10 mm. The primary endpoint was successful lesion access with no more than two needle repositionings. Baseline characteristics were comparable between groups, and the intervention used automatic gantry-mounted laser navigation to project the planned trajectory onto the patient. Secondary endpoints included needle-tip error, CT scan counts, puncture time, and complications recorded during the procedure.

Mean targeting error was 2.1±0.9 mm with laser guidance and 3.5±0.8 mm with freehand technique, with P<.001 for the between-group difference. The primary analysis also showed a significant difference in successful puncture rate at P<.001. Operators needed fewer confirmatory scans, averaging 4.1±2.1 versus 4.9±2.4, with P=.014. Together, these results paired greater targeting precision with fewer verification scans during lesion access.

Puncture duration was similar between groups, averaging 18.3±4.1 minutes with laser guidance and 19.0±5.2 minutes with freehand technique, with P=.45. Major complication rates were low and similar at about 5% in each group, with P=1.00 for the between-group comparison. Those events consisted of pneumothoraces requiring chest tubes in each arm, without an excess in the laser-guided group. The authors characterized gantry-mounted laser guidance as an efficient, low-cost alternative to freehand technique. The reported accuracy gains were not accompanied by a difference in puncture duration.