Researchers at Case Western Reserve University (CWRU, Cleveland, OH, USA) and Vanderbilt University (Nashville, TN, USA) are spearheading a groundbreaking approach to prostate cancer surgery by integrating advanced robotics with “low-field” MRI technology. This research aims to achieve highly precise, personalized prostate cancer surgeries without the need for traditional incisions. This innovative work represents a significant advancement in minimally invasive prostate cancer treatments, with the potential to enhance both patient safety and procedural efficiency.

The research team plans to adapt a robotic system from Virtuoso Surgical Inc. (Nashville, TN, USA) to remove prostate cancer lesions, combining it with Promaxo Inc.’s (Oakland, CA, USA) MRI technology. The Virtuoso Surgical system features two robotically controlled, needle-sized manipulators working from the tip of a rigid endoscope that is less than half the diameter of a U.S. dime. This endoscope is significantly smaller than current robotic endoscope systems, and its manipulators are just 1mm in diameter. Equipped with a camera, the endoscope offers a variety of tools depending on the procedure, such as a tissue grasper, retractor, tissue snare, laser aiming manipulator, and electrosurgical devices. Virtuoso is progressing toward the commercialization of its robotic surgical system and also exploring the application of its robotic technology for bladder lesion removal. While initial clinical applications are likely to focus on bladder lesions and benign prostatic hyperplasia (BPH) tissue removal, this technology has the potential to enhance numerous surgical procedures performed through rigid endoscopes.

Unlike traditional transrectal ultrasound, Promaxo’s MRI can image the prostate without obstructing surgical access to the lesions. Promaxo’s MRI system, FDA cleared for in-office use, integrates AI-based imaging to guide prostate interventions with precision. Designed for ease of transport and installation, Promaxo’s MRI can be set up in a standard physician’s office with minimal facility modifications. Unlike conventional MRI systems, it does not require hazardous materials or complex safety protocols, such as quenching. The system's confined fringe field eliminates the need for RF shielding, while its quieter operation and low energy consumption make it both patient-friendly and cost-effective.

“Our goal is to eliminate the many complications associated with whole-gland prostate removal to treat prostate cancer,” said William Grissom, the Medtronic Professor of Biomedical Discovery and Innovation at the Case Western Reserve School of Medicine and Case School of Engineering. “Targeted removal of localized prostate lesions could alleviate these complications but is challenging because cancerous tissue can appear identical to healthy tissue in endoscopic images, making accurate surgery difficult.”

“The new robot will be able to carefully guide surgical instruments directly to prostate cancer lesions identified in high-field MR images,” added Robert Webster, the Richard A. Schroeder Professor of Mechanical Engineering at Vanderbilt University. “This will enable surgeons to focus treatment on specific cancerous lesions.” 

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