Computer-guided pericardiocentesis: Experimental results and clinical perspectives

Percutaneous pericardial puncture is a relatively safe and effective techni que in case of large pericardial effusions when practiced under echographic or radiological control. The goal of our project is to improve the perform ance of this technique, mainly in case of smaller and loculated effusions u sing an accurate guidance towards a preplanned target, based on a model of the pericardial effusion. This paper presents preclinical results of this n ew computer-assisted technique used to reach the pericardial cavity. The procedure is divided into 3 steps: 1. acquisition of ultrasound data, u sing an echocardiographic device connected to a 3-D localizer and to a comp uter, 2. modeling procedure to define the optimal strategy taking into acco unt the mobility of organs on a digital model, 3. guided puncture with a lo calized needle to reach the predefined target using a passive guidance syst em. After validation on a dynamic phantom and a feasibility study on dogs, an accuracy and reliability analysis protocol was realized on pigs with exp erimental pericardial effusion. Feasibility of the technique is demonstrated on animal study with an accura cy of at least 2.5 mm. Further clinical investigation is in progress using a more ergonomic and less cumbersome system. This study demonstrates the feasibility of computer-assisted pericardiocent esis. Beyond the simple improvement of the current technique, this could be a new way to reach the heart or a new tool for percutaneous access and ima ge-guided puncture of soft tissues.