Ultrasound Based Transperineal Robotic Biopsy of the the Prostate
Ultrasound Based Transperineal Robotic Biopsy of the the Prostate
The objective of the study is to examine the effectiveness and accuracy of the BioXbot in
 prostate biopsy as opposed to transrectal biopsy. This evaluation of the efficacy of both the
 procedures is based on:

 -  Uptake rate

 -  Peripheral zone reachability

 -  Needling accuracy

 -  Procedure execution time

 -  Post operative discomfort or trauma experienced by patient

 -  Quality and type of tissue sample extracted

 -  Adverse and unanticipated side-effects on patient after the procedure and recording any
 unexpected reactions
The prostate gland is a walnut-sized organ found only in men that encircles the urethra
 (urine passage) below the urinary bladder. It secretes fluid that is an important component
 of semen. Prostate cancer is a disease of the prostate gland where malignant tumours cells
 invade normal prostate tissue and spread to other organs. It is second leading cause of
 cancer death in men and it is mainly found in men above the age of 50 years.

 Prostate biopsy is considered to be the most definitive diagnostic tool for prostate cancer.
 It is a surgical procedure in which a small sample of tissue is removed from the prostate
 gland and examined by a pathologist. The procedure normally takes about 15 minutes and is
 usually performed by the urologist in conjunction with transrectal ultrasound (TRUS). No
 anesthetic is required. With the help of TRUS, a doctor guides a biopsy gun -- a hand-held
 device with a spring-loaded, slender needle -- through the wall of the rectum into the area
 of the prostate gland that appears abnormal. Since the rectal wall is thin, it is possible to
 place the needle more accurately and with less injury to other tissues. When activated, the
 needle can remove a slender cylinder of tissue, called a core.

 Transrectal ultrasound-guided prostate biopsy has become the standard for obtaining tissue
 for the histological diagnosis of prostate cancer. On the other hand, transperineal approach
 is not commonly used worldwide and little data is available on transperineal prostate biopsy.

 However, there are some problems with existing system and these include:

 -  Random Biopsy Sites: Biopsy cores represent only about 0.6% of the prostate in terms of
 volume. Therefore, without having accurate knowledge of cancer sites, it is unlikely
 that a random biopsy protocol will yield consistently high cancer detection rates.

 -  Inaccurate Needling: The biopsy needle may not reach the desired position accurately and
 quickly under manual control.

 -  Limited 2D Guidance: The TRUS used for biopsy guidance is 2D ultrasound images. As the
 biopsy sites are distributed in 3D, it is difficult for the surgeon to imagine the
 overall picture of the biopsy sites and identify the biopsy site accurately and
 intuitively.

 -  Risk Factors: The two primary risks of needle biopsy are severe bleeding and infection
 of the prostate gland or urinary tract.

 -  Transrectal Shortfalls: As most of the cancer occurs at the apex area of the prostate,
 transperineal biopsy is considered having higher chance to get cancer tissue, comparing
 with the conventional transrectal biopsy. Furthermore, transperineal biopsy is
 considered "cleaner", as its puncture point is on skin, rather than on rectum.

 To assist the surgeon in transperineal biopsy, a device name BioXbot has been designed.
 BioXbot aims to address the shortfalls of the transrectal method of biopsy and limitations of
 existing robotic biopsy in order to improve the cancer uptake rate. An ideal design should
 need no more than 2 operators to complete the procedure comfortable within comparable time
 with the conventional approach. A motorized needle positioning mechanism may also improve the
 accuracy in the needling and allow the needle reach any point within the prostate in all
 scenarios.

 BioXbot is a computer based motion control system with software driven gantry mechanism to
 assist in the positioning of the biopsy gun. It drives a 2D ultrasound probe to obtain a
 series of 2D images of the prostate which will then be modeled into a 3D view. This 3D
 visualization gives the surgeon a better idea of the prostate and allows him to plan the
 biopsy sites more intuitively. The mechanical components precisely align it to allow the
 clinician to accurately reach the position inside the prostate he wanted to and obtain tissue
 from there. To improve the usability and the positioning accuracy, as well as reducing the
 operation time, the positioning of the needle is fully motorized.
Inclusion Criteria:

 -  At least one normal previous prostate biopsy and at least 2 weeks since prior prostate
 biopsy

 -  Increasing prostate-specific antigen (PSA) level

 -  The Investigator has completed a medical history and a physical examination to assure
 that the subjects meet all study enrollment criteria

 Exclusion Criteria:

 -  Patient with operative risk ASA ( American Society of Anaesthesia) = or > 4

 -  A history of bleeding disorders/coagulopathy or ongoing treatment for this condition

 -  Patients with psychiatric diseases or insufficient cerebral function