Surgical robots can make radical prostatectomy safer and less invasive

Robert Webster III (left) and Duke Harrell. Credit: VUMC

Researchers at the Vanderbild Institute for Surgical Engineering have developed a tiny robot that could revolutionize surgery to treat prostate cancer, which affects one in nine men in the United States. Using a realistic model, the team demonstrated that a surgical robot can not only remove the prostate and tissue from the urethra, but also perform the difficult step of suturing the bladder into the urethra.

An article describing their study, “Transurethral Anastomosis After Transurethral Radical Prostatectomy: A Phantom Study of Intraluminal Suture with Concentric Robots,” was published in the journal. Electrical and Electronic Engineers Association..

A typical radical prostatectomy, which is the standard treatment for prostate cancer, requires the abdomen to be removed to reach the prostate. This amputation and exposure of healthy tissues and nerves can cause incontinence and erectile dysfunction in some people undergoing treatment. There is no current alternative endoscopic removal technique because there are no instruments available that enable such small-scale surgical dexterity.

Robert Webster, Professor of Mechanical Engineering, Richard A. Schroeder, and Associate Professor of Medicine and Urology have spent their careers developing concentric robots that enable this dexterity with endoscopy. He and Duke Herrell, a professor of urology and biomedicine and mechanical engineering, have developed a surgical robot platform with two arms made of telescopic needle-sized tubes and operated by software-controlled technology.

Following the invention in 2005, Webster and now Herrell, along with a team of Vanderbilt researchers including assistant professor Nick Kavoussi in urology, graduate student Dominick Ropella, postdoctoral fellow Ernar Amanov, and fellow Naren Nimmaggada, are prototype robots. Has been further developed into a usable tool. It works in the urethra, which is a fraction of an inch in diameter.

Surgical robots can make radical prostatectomy safer and less invasive

(A) First the needle arm penetrates the urethra and bladder, then (B) grabs the suture using the basket, then (C) pulls the suture through the bladder and then through the urethral wall. After this, the (D) manipulator arm grabs the suture and returns it to the bladder in preparation for the next stitch. (E) Diagram of the final anastomosis from the perspective of an endoscope. Credits: Webster, Herrell, et. al

“The biggest cause of the challenge we are trying to solve is the size of the urethra,” said Webster, also a VISE faculty member at the Institute for Biomedical Engineering and Discovery. “Sewing in this size area is a very technical challenge. We are working on a scale that is too small for other equipment to reliably perform this procedure.”

After removing the prostate through the urethra, the surgeon can operate a concentric tube robot to suture the urethra exactly to the neck of the bladder. A procedure called anastomosis is one of the most difficult steps and is essential for the recovery of urinary function. Herrell and Webster also believe that the surrounding structures, including ligaments and nerves for sexual function, remain intact, reducing trauma and traction and reducing the incidence of surgical complications.

During the procedure, the rigid endoscope carries two concentric tube manipulator arms into the urethra. Once delivered, the needle arm penetrates the tissue and pulls the suture. The second arm grabs the suture and returns it to the bladder. Webster, a professor of head and neck surgery in electrical engineering, neurosurgery, and otolaryngology, explained that the anastomotic part of the procedure was completed within 7-8 needles.

Regarding the development of this technology, Webster said: “It’s the unplanned interaction between VISE surgeons and engineers that makes all the difference in our work. The origin of this idea is what happens when the laser he uses is added. Came from wondering aloud. One of our robotic devices and instruments has been scaled down to fit into a standard endoscopic profile. VISE is an innovative new idea. It promotes many of these brainstorming interactions that are species. “

In the future, MEDLab will continue to experiment with this procedure and its applicability for suturing other microregions in the body.

Handheld robot points to less invasive prostate surgery

For more information:
Ernar Amanov et al. Transurethral anastomosis after radical radical prostatectomy: Phantom study of intraluminal suture with concentric robots, IEEE Transactions on Medical Robotics and Bionics (2020). DOI: 10.1109 / TMRB.2020.3034735

Provided by Vanderbilt University

Quote: Surgical robots based on radical prostatectomy obtained on February 11, 2021 from Can be safe and minimally invasive (February 11, 2021)

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Surgical robots can make radical prostatectomy safer and less invasive

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