20 Fall / Automne 2017 M edical Robots technology is offered through a range of products. Surgical robots have been developed or are under development for the following therapies: (i) Minimally invasive prostate surgery in closed-bore MRI, (ii) Minimally invasive general surgery in closed-bore MRI. The robots are modular and re-configurable to allow mounting and fitting into the MRI environment. The robots are semi-autonomous. They are remotely controlled when operating in the human body through MRI and PC-based images. The robots are endowed with advanced Operator Control Units allowing complete control of the interventions. The robots can be adapted to other surgical procedures and organs by exchanging therapy-focused modular subsystems of the robot. Robot and patient in the MRI interface for robot control and image display; (vi) laser dispenser, power, and control; (vii) MRI monitoring sta- tion (including MR Temperature map- ping). The robot system could be adapted for operation in 1.5T - 3T MRI scanners. The robot is functional simultaneously while the scanner is operating without affecting the images or the robot operation. During surgical procedures, the patient lies on the MRI roll-in table with leg supports attached to the table (shown schematically). The robot is mounted & secured onto the table and between patient’s legs. The robot controller is at a distance from the scanner, connected to the robot, and to the Laptop that is in the adja- cent control room. The surgeon will remotely manipulate the tools based on MRI and laptop-based images using a hand controller (joystick) or manually. Control of surgical tool penetration is based on visual feed- back provided by MR imaging. The image allows the user to identify the tool tip location relative to the target, and perform suitable adjustments of the tool path to reach the target. When the tool is at the target, the laser is turned on, and ablation of tissue is performed. MR thermog- raphy allows for real time imaging of tissue destruction. After the ablation process is completed, the scanner provides images of the heated and coagulated volumes of tissue. The technological features of one such robot are: ● Modular Design: Surgical tool support (trocar) allows for a variety of tools to be used ● MRI-compatible ● Rugged and compact design ● Bio-compatible ● Safe and efficient in the MR environment resulting in cell death without untoward patient effects ● Brachytherapy - insertion of radioactive seeds in the gland ● Biopsy – extraction of tissue samples from the gland based on established protocols The image-guided surgical interven- tions in closed-bore MRI may be performed using either: ● a remotely-controlled surgical robot tool; or ● a manually-controlled instru- mented surgical tool The surgical tool is identical in both approaches. It is carried by either the surgical robot tool or by the instru- mented tool. The procedures are image-guided. One major issue is that the surgical tools and carriers must be MRI-com- patible; that is, the robot or instru- mented tool and the MRI would not affect each other (the imaging process and carrier operation, respectively). The technology also includes a meth- odology of evaluating the therapy (ablation) by real-time MRI scanning during and post-intervention. The new technology provides high added value to the medical practice as it would impact on both precision of surgical procedures and reduction of side effects that may appear post- interventional and affect the quality of life. The robotic platform includes: (i) a six- joint robot; (ii) robot- based trocar for mounting surgical tools; (iii) hand con- troller for navigating the surgical tool by remote control; (iv) robot controller; (v) a laptop-based user Image-guided focal ablation of the dominant focus in selected men with low to low-intermediate risk cancer can control spread of the cancer from the prostate in most men and render it a chronic disease that is largely devoid of side effects. This paradigm treatment shift is not dissimilar to treatment of colonic polyps by colon- oscopy as opposed to colectomy or lumpectomy for localized breast can- cer instead of mastectomy. The ideal implementation of this con- cept is with a minimally invasive robot-assisted MRI-guided focal ablation system. The procedure is performed in closed-bore MRI that is considered superior to other tech- niques of image-guided interventions (open-bore MRI, Ultrasound, Com- puterized Tomography (CT) scan). The procedure uniquely integrates direct cancer imaging, real time precision computer-aided navigation of the tool to the target, optimal energy distribution into the target, real time imaging of tissue destruction using MR thermography for visual confirm- ation of target destruction. The robot could be used with different surgical tools to perform a range of prostatic interventions: ● Ablation - thermal lesions Prostate cancer is the most common cause of cancer in men and the second-most common cause of mor- tality due to cancer. Publicly avail- able information indicates that more than 230,000 men are diagnosed each year in North America. A con- servative estimate of the prevalence of prostate cancer in North American males in the age range of 55 to 69 is 7,500,000 men. The traditional curative treatments of this disease include radical surgery and external or interstitial radiation therapy. These are reasonably effect- ive for localized cancer, but are associ- ated with significant quality of life penalties. These may include incontin- ence, impotence, bowel dysfunction, and prolonged recovery. The cause of these problems is not removal of the prostate but damage to surrounding tissue and nerves. While most believe that prostate can- cer is a multi-focal disease, recent evidence supports the notion of a dominant focus that is the largest of intra-prostatic cancer sites and the major source of extra-prostatic spread (90%). Recent improvements in imaging of tissue by magnetic res- onance scanning have allowed for the visualization of these sites. MRI Prostate Focal Ablation Robot MRI-GUIDED ROBOT-ASSISTED IN-BORE PROSTATE SURGERY Medical Robots 20 Fall / Automne 2017 Robot and patient in the MRI ra ● B sa es The tio pe ● r ● m The ...Continued on page 21