Robotic navigation and precision in lung nodule microwave ablation

Aim: Robotic-assisted puncture systems have been developed, but evidence for their use in percutaneous microwave ablation (MWA) of lung nodules remains limited. Methods: This retrospective single-center study included 183 patients who underwent computed tomography (CT)-guided percutaneous MWA for pulmonary nodules < 3 cm between March 2024 and April 2025. Patients underwent robotic-assisted or conventional freehand puncture. After 1:1 propensity score matching, technical success, puncture deviation, intraprocedural CT acquisitions, needle adjustments, and complications were compared. Multivariable logistic regression, subgroup analyses, and learning-curve analysis were performed. The study was approved by the Institutional Review Board of the First Affiliated Hospital of Guangzhou Medical University (ES-2026-K212-02) on 23 June 2026. The requirement for individual written informed consent for study participation was waived due to the retrospective nature of the study; patients were covered under the hospital's general informed consent for hospitalization. Written informed consent was obtained from all patients for the procedure. Results: After matching, 86 patients were included (43 per group), with comparable baseline characteristics and 100% technical success in both groups. Compared with freehand puncture, robotic-assisted navigation was associated with significantly reduced puncture deviation (median [IQR], 3.0 [2.0-4.5] vs. 6.0 [5.0-9.5] mm), intraprocedural CT scans (2.0 [1.5-2.0] vs. 5.0 [5.0-7.0]), and needle adjustments (2.0 [1.5-2.0] vs. 4.0 [3.0-4.0]; all P < 0.01). Robotic-assisted navigation was associated with a lower overall complication rate (46.51% vs. 81.40%; P < 0.01), driven mainly by reduced pneumothorax (27.91% vs. 69.77%; P < 0.01) and chest drain insertion rates (4.65% vs. 20.93%; P = 0.02). Multivariable analysis robotic-assisted puncture remained independently associated with a lower risk of pneumothorax (OR 0.160, 95%CI: 0.061-0.420, P < 0.001). Subgroup analyses showed consistent benefits across strata. Procedural performance stabilized after approximately 24 robotic-assisted cases. Conclusion: Robotic-assisted navigation was associated with greater procedural precision, efficiency, and safety in CT-guided percutaneous MWA, while demonstrating consistent performance across different lesion characteristics and a relatively short learning curve. It may serve as a reproducible and standardized platform for percutaneous pulmonary ablation.