IEEE Trans Biomed Eng. 2019 Sep;66(9):2527-2537. doi: 10.1109/TBME.2019.2891240. Epub 2019 Jan 7.
We present a robot-assisted approach for transrectal ultrasound (TRUS) guided prostate biopsy. The robot is a hands-free probe manipulator that moves the probe with the same 4 DoF that are used manually. Software was developed for three-dimensional (3-D) imaging, biopsy planning, robot control, and navigation. Methods to minimize the deformation of the prostate caused by the probe at 3-D imaging and needle targeting were developed to reduce biopsy targeting errors. We also present a prostate coordinate system (PCS). The PCS helps defining a systematic biopsy plan without the need for prostate segmentation. Comprehensive tests were performed, including two bench tests, one imaging test, two in vitro targeting tests, and an IRB-approved clinical trial on five patients. Preclinical tests showed that image-based needle targeting can be accomplished with accuracy on the order of 1 mm. Prostate biopsy can be accomplished with minimal TRUS pressure on the gland and submillimetric prostate deformations. All five clinical cases were successful with an average procedure time of 13 min and millimeter targeting accuracy. Hands-free TRUS operation, transrectal TRUS guided prostate biopsy with minimal prostate deformations, and the PCS-based biopsy plan are novel methods. Robot-assisted prostate biopsy is safe and feasible. Accurate needle targeting has the potential to increase the detection of clinically significant prostate cancer.
我们提出了一种机器人辅助经直肠超声（TRUS）引导前列腺活检的方法。机器人是一种免提探头操纵器，其移动探头的自由度与手动操作相同，为 4 个自由度。开发了用于三维（3D）成像、活检规划、机器人控制和导航的软件。开发了用于最小化探头在 3D 成像和针靶向时引起的前列腺变形的方法，以减少活检靶向误差。我们还提出了一种前列腺坐标系（PCS）。PCS 有助于在无需前列腺分割的情况下定义系统活检计划。进行了全面的测试，包括两个台架测试、一个成像测试、两个体外靶向测试以及对五名患者进行的经 IRB 批准的临床试验。临床前测试表明，基于图像的针靶向可以达到毫米级的精度。可以在对腺体的 TRUS 压力最小和前列腺变形亚毫米的情况下完成前列腺活检。所有五个临床病例均成功，平均手术时间为 13 分钟，靶向精度为毫米级。免提 TRUS 操作、经直肠 TRUS 引导的前列腺活检且前列腺变形最小化以及基于 PCS 的活检计划是新颖的方法。机器人辅助前列腺活检是安全且可行的。准确的针靶向有可能提高对临床显著前列腺癌的检出率。
