Toward Image-Guided, Robot-Assisted Focal Prostate Resection: Do Enhanced Dexterity and Visualization Improve Performance?

Focal prostate treatment (aka "male lumpectomy") has the potential to reduce invasiveness for prostate cancer patients. However, clinical deployment has been impeded by the difficulty of performing surgery through the urethra, which we hypothesize relates to both instrument dexterity and visualization limitations. To evaluate this hypothesis, in this paper we propose a system consisting of an endoscopic robot to enhance dexterity and an image-guidance display updated periodically during surgery based on MRI images. To evaluate the system, in this paper we compare four conditions: unaided manual resection using an endoscope, robot-aided surgery without image guidance, image guidance without the robot, and both robot and image guidance together. We find that while the robot and image guidance improve performance individually, the combination of the two provides the greatest improvement.