Reviews of the AprioMed Morrison Steerable Needle | Which Medical Device

Steerable devices with variable curvature are becoming increasingly common in interventional radiology. These range from the Courier ENZO microcatheter www.whichmedicaldevice.com/by-manufacturer/52/66/courier-enzo-microcatheter to steerable sheaths such as the Destino sheath by Oscor (http://www.oscor.com/medical-devices/adelante-destino.html). They allow us to reach vessels that may otherwise have been impossible or very difficult to reach with standard equipment.  The Morrison steerable needle (Apriomed) is a logical addition for non vascular work. This clever needle has a steerable central stylet that allows the 21g needle to be inserted along a curved trajectory around intervening structures to allow FNA biopsy or guidewire insertion. The angle of curvature can be adjusted by altering a lever on the end of the central stylet even whilst the needle is within the body. This allows an unprecedented degree of access to different regions of the body.

 

This 73 year old patient presented with a small right lower pole renal mass measuring  23mm that was considered suitable for radio frequency ablation (RFA) (fig 1).

 

 

The patient was positioned prone on the CT table and a contrast enhanced scan performed to delineate the tumour. It became immediately apparent that the colon was too close to the ablation zone and that it would need to be displaced by injection of 5% dextrose solution (hydrodissection).  The patient’s mobility made it very difficult to obtain an oblique position to access the space between the spleen and colon and it was decided that the Morrison steerable needle would make access easier and safer using a curved trajectory. This enabled me to pass the needle between the colon and kidney whilst avoiding traversing the liver which would have occurred with a more lateral approach.

 

The needle was inserted with intermittent CT scanning . Once it had traversed the initial subcutaneous and muscle layers (fig 2)

 

 

it was easily curved by adjusting the lever on the end of the stylet (fig 3).

 

 

The curve then allowed me to safely advance the needle around the anterior surface of the kidney between the kidney and colon (fig 4).

 

 

250ml of 5% dextrose was then injected displacing the colon. RFA was then performed successfully without any damage to the adjacent colon (fig 5)

 

 

This procedure was undoubtedly made easier and safer with this steerable needle. Hydrodissection would have been otherwise challenging due to poor patient mobility and the close proximity of the liver.

 

Dr Phil Haslam

Consultant Interventional Radiologist