In May of 2023, Govindarajan Narayanan, M.D., became the first physician to use the Epione robot in the U.S., performing an image-guided microwave ablation on a patient with a liver tumor. It’s a milestone that he believes has the potential to revolutionize the way image-guided ablations are performed to treat patients with primary and secondary liver cancer.
Today, more than 50 cases later, Dr. Narayanan, chief of interventional oncology at Miami Cancer Institute and an interventional radiologist with Miami Cardiac & Vascular Institute, both part of Baptist Health, is seeing the tangible benefits for the hospital system, healthcare providers and patients.
“As a high-volume center, our goal is to work quickly, precisely and efficiently to be able to provide the best care to our patients,” he said. “Using the Epione robot, we are able to move more quickly through our cases, enhancing our productivity and lessening wait times. There are other significant benefits as well, including the reduction in radiation exposure to patients and doctors. Baptist Health saw the impact pretty quickly.”
More than 41,000 new cases of liver cancer are diagnosed in the U.S. each year, according to the American Cancer Society. Patients whose liver lesions can be removed surgically typically have the best outcomes, yet up to 75 percent of patients are not good candidates for surgical resection because they have multiple tumors or their liver function is poor. The FDA has approved the Epione system for the treatment of all abdominal cancers.
The innovative technology transforms the physician’s workflow. Planning software delineates the trajectory for multiple needle insertions, if required, and transfers CT images to a workstation in the procedure room. Because the robot pinpoints where the needles should go and the needles are pushed from skin to target, fewer adjustments need to be made. That results in a reduced need for images, lowering cumulative radiation exposure.
Another important feature is the ability to segment the tumor volume and the ablation zone after completing the treatment, as well as fusing images. “With image fusion, we can ensure that we’ve achieved good margins, which is vital,” Dr. Narayanan said. In addition, patients always appreciate minimally invasive treatments and are typically able to return home the day after the procedure.
The adoption of minimally invasive procedures such as radiofrequency ablation, microwave ablation, irreversible electroporation (IRE) and cryoablation to treat liver and other abdominal cancers is on the rise. However, for continued improvement in accuracy, outcomes and access to quality care, more advanced training in the newest technologies is needed.
The good news, Dr. Narayanan said, is that although there is a learning curve with the robot, users are able to quickly pick up the skills necessary to operate the robotic system. While acknowledging that the robot might not be the best choice for smaller-volume programs, he believes it is ideal for comprehensive cancer centers like Miami Cancer Institute.
Dr. Narayanan will be sharing outcomes data from the Institute’s experience with Epione at the Society of Interventional Radiology Annual Scientific Meeting, March 23-27, in Salt Lake City.
