System for Robotically Assisted Prostate Biopsy and Therapy with Intraoperative CT Guidance

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the work-in-progress prototype of an image-guided, robotic system for accurate and consistent placement of transperineal needles into the prostate with intraoperative image guidance inside the gantry of a computed tomographic (CT) scanner. MATERIALS AND METHODS: The coach-mounted system consists of a seven-degrees-of-freedom, passive mounting arm: a remote-center-of-motion robot; and a motorized, radiolucent needle-insertion device to deliver 17-18-gauge implant and biopsy needles into the prostate with the transperineal route. The robot is registered to the image space with a stereotactic adapter. The surgeon plans and controls the intervention in the CT scanner room with a desktop computer that receives DICOM images from the CT scanner. The complete system fits in a carry-on suitcase, does not need calibration, and does not utilize vendor-specific features of the CT scanner. RESULTS: In open air, the average accuracy was better than 1 mm at a 5-8-cm depth. In various phantoms, the average orientation error was 1.3 degrees, and the average distance between the needle tip and the target was 2 mm. CONCLUSION: Results of preliminary experiments indicate that this robotic system may be suitable for transperineal needle placement into the prostate and shows potential in a variety of other percutaneous clinical applications.