Toward Low-Field MRI Guided Robotic Transurethral Focal Prostate Resection: A Feasibility Study Using High-Field Images

We seek to enable transurethral focal resection of prostate tumors via enhanced robotic dexterity, combined with MRI image guidance. Our approach is designed to reduce invasiveness compared to traditional transabdominal radical prostatectomy, with the goal of reducing rates of impotence, incontinence, and other complications. MRI guidance is useful in focal resections since many prostate tumors look optically no different from the surrounding prostate, but can be seen in preoperative MRI images. To guide these procedures in a practical clinical setting, we envision using the new generation of low-field scanners emerging on the market, in conjunction with endoscope-deployed concentric tube robots. These scanners would provide periodic intraoperative imaging to which one would register the preoperative high-field images in which the tumor is visualized. In this paper, we conduct a feasibility study to explore whether our robot and image guidance system can help guide the resection of tumors that are invisible optically. In our experiments, surgeons used our robot with periodic highfield MRI image updates, to resect an optically invisible tumor in an anthropomorphic prostate phantom. We show how the availability of imaging information informed both the direction and depth with which surgeons chose to resect the tumor.