Pindara Private Hospital recently trialled worldleading robotic technology for prostate biopsies, enabling more accurate diagnosis and treatment. According to Urologist Dr Charles Chabert, the Artemis/ProFuse platform uses innovative robotic and MRI technology combined with the latest transperineal surgical approach to produce safer and more precise biopsies. "The first global application of the Artemis transperineal system was in Switzerland recently. It’s pleasing to see this world-class technology now available to benefit patients at Pindara Private Hospital," said Dr Chabert. Prostatic biopsies have traditionally been performed using transrectal ultrasound guided needle placement. This can be associated with an increased risk of infection and can make access of anteriorly placed lesions difficult. In more recent times there has been a trend towards performing these biopsies in a ‘transperineal’ fashion. This avoids placing needles through the bowel wall, which allows better access to the front part or anterior aspect of the prostate. The introduction of multiparametric (mp) MRI prostate scans has led to not only a reduction in the number of biopsies that need to be performed but also results in a more targeted, focused approach. Until recently, cognitive fusion - which relies on a surgeon’s ability to cognitively overlay real time ultrasound images with a previously obtained mp MRI - has been performed. Whilst this is a significant step forward, there are potential limitations with this approach, particularly with larger sized prostates and smaller sized lesions or ‘targets’. To overcome this pitfall, there are different platforms now available that aim to remove the guesswork with the fusion process and provide a more accurate, reliable, and reproducible platform to perform targeted prostatic biopsies. The Artemis/ProFuse platform is one such platform and is the only system available that is based on a combination of 3D semi-robotic tracking and deformable MR-Ultrasound fusion. The Artemis platform uses a mechanical robotic arm to stabilize and hold the ultrasound probe (i.e. no freehand) and track it continuously in 3D. This eliminates the deformation of the prostate during the biopsy procedure and leads to accurate and reproducible biopsy targeting. Artemis' motion compensation feature allows real time correction for intra-procedure prostate motion. In addition, all biopsies that are taken are recorded on a 3D map, which lets the doctor know where a patient’s disease might be located so that if they were to be managed with active surveillance, a precise map of the area requiring any future monitoring is available, once again removing the guesswork. The Artemis platform also allows for accurate overlay of MRI-defined lesions on real-time ultrasound. The prostate is not static, moreover, it is prone to significant movements due to breathing, bladder volume and changes in bowel filling. Deformable fusion is necessary to account for these shape changes during the initial MRultrasound fusion planning, and in conjunction with robotic mechanical tracking, it eliminates subsequent freehand deformation during the procedure as well. The Artemis system is the first MRI/trus fusion system able to function in a transperineal as well as a transrectal approach. The Artemis/ ProFuse platform provides a unique, accurate and reproducible biopsy targeting and therapy planning platform which can allow more accurate and selective prostatic biopsies. The first global application of the Artemis transperineal system was in Switzerland recently followed by Pindara Private Hospital. pindaramagazine.com.au Pindara Magazine 39
Pindara Private Hospital Magazine - Issue Eight
To see the actual publication please follow the link above