Toward Improving Transurethral Prostate Surgery: Development and Initial Experiments with a Prototype Concentric Tube Robotic Platform.

INTRODUCTION Despite the potential clinical advantages of holmium laser enucleation of the prostate (HoLEP), there has been reluctance of the urologic community to adopt the procedure, as a result of a perceived steep learning curve. Thus, we sought to design and develop a transurethral endoscopic robotic platform for HoLEP. MATERIALS AND METHODS We developed a novel transurethral, concentric tube robotic platform for HoLEP. We conducted magnetic tracking experiments to compare movements of the end effectors of the robot with those of a rigid endoscope. Additionally, we tested the robot on an HoLEP simulator and with a human cadaveric prostate to assess its ability to maneuver within a small working space. RESULTS In the prostate scanning experiment, the area reached by the robot represents a 65% improvement vs the area accessible by a rigid endoscope without tissue deformation. Additionally, the robot performed well within the confines of the prostatic urethra and was able to successfully complete prostate lobe enucleation, on both the HoLEP simulator and with a human cadaveric prostate. CONCLUSIONS We have developed a concentric tube robotic platform that is passed through a standard endoscope that is capable of producing complex movements of the end effectors. We have shown that these movements of the concentric tube manipulators are capable of performing tasks that may eventually translate into improved ease of performing HoLEP.

[1]  Robert J. Webster,et al.  A multi-arm hand-held robotic system for transurethral laser Prostate surgery , 2014, 2014 IEEE International Conference on Robotics and Automation (ICRA).

[2]  K. McVary BPH: epidemiology and comorbidities. , 2006, The American journal of managed care.

[3]  J. Lingeman,et al.  Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. , 2010, The Journal of urology.

[4]  E. Mathus-Vliegen,et al.  Epidemiology and Comorbidities , 2018 .

[5]  Serge Carrier,et al.  GreenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. , 2015, The Journal of urology.

[6]  Nabil Simaan,et al.  A pilot ex vivo evaluation of a telerobotic system for transurethral intervention and surveillance. , 2015, Journal of endourology.

[7]  S. Ahyai,et al.  Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. , 2004, The Journal of urology.

[8]  M. Elhilali,et al.  Holmium laser enucleation of the prostate: a size-independent new "gold standard". , 2005, Urology.

[9]  Seung-June Oh,et al.  Technical Aspects of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia , 2013, Korean journal of urology.

[10]  Eduardo Sánchez de Badajoz,et al.  [New master arm for transurethral resection with a robot]. , 2002, Archivos espanoles de urologia.

[11]  Alexander Bachmann,et al.  A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. , 2015, European Urology.

[12]  B L Davies,et al.  The Development of a Surgeon Robot for Prostatectomies , 1991, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[13]  Paolo Dario,et al.  A Novel Robotic Platform for Laser-Assisted Transurethral Surgery of the Prostate , 2015, IEEE Transactions on Biomedical Engineering.

[14]  J. Manresa,et al.  Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve. , 2009, Urology.

[15]  M M Elhilali,et al.  Holmium laser enucleation of the prostate can be taught: the first learning experience , 2002, BJU international.

[16]  Pierre I Karakiewicz,et al.  Morbidity and mortality after benign prostatic hyperplasia surgery: data from the American College of Surgeons national surgical quality improvement program. , 2014, Journal of endourology.

[17]  Andrea Salonia,et al.  Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. , 2006, European urology.

[18]  F. Montorsi,et al.  Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. , 2010, European urology.

[19]  Nobuhiko Hata,et al.  A tubular organ resection manipulator for transurethral resection of the prostate , 2004, 2004 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) (IEEE Cat. No.04CH37566).

[20]  Qi Chen,et al.  A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup. , 2013, The Journal of urology.

[21]  Hemendra N Shah,et al.  Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. , 2007, The Journal of urology.

[22]  Naoko Kinukawa,et al.  Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. , 2003, The Journal of urology.