Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;2(4):578-581.
doi: 10.1109/tmrb.2020.3034735. Epub 2020 Oct 29.

Transurethral Anastomosis after Transurethral Radical Prostatectomy: A Phantom Study on Intraluminal Suturing With Concentric Tube Robots

Ernar Amanov  1   2 , Dominick S Ropella  1   2 , Naren Nimmagadda  3 , Tayfun E Ertop  1   2 , Jason E Mitchell  1 , Nicholas L Kavoussi  3 , Richard J Hendrick  4 , Neal Dillon  4 , Evan Blum  4 , S Duke Herrell 3rd  1   3   2 , Robert J Webster 3rd  1   3   2
Affiliations

Transurethral Anastomosis after Transurethral Radical Prostatectomy: A Phantom Study on Intraluminal Suturing With Concentric Tube Robots

Ernar Amanov et al. IEEE Trans Med Robot Bionics. 2020 Nov.

Abstract

Current surgical approaches to radical prostatectomy are associated with high rates of erectile dysfunction and incontinence. These complications occur secondary to the disruption of surrounding healthy tissue, which is required to expose the prostate. The urethra offers the least invasive access to the prostate, and feasibility has been demonstrated of enucleating the prostate with an endoscope using Holmium laser, which can itself be aimed by concentric tube robots. However, the transurethral approach to radical prostatectomy has thus far been limited by the lack of a suitable means to perform an anastomosis of the urethra to the bladder after prostate removal. Only a few intraluminal anastomotic devices currently exist, and none are small enough to pass through the urethra. In this paper we describe a new way to perform an anastomosis in the small luminal space of the urethra, harnessing the dexterity and customizability of concentric tube manipulators. We demonstrate a successful initial proof-of-concept anastomosis in an anthropomorphic phantom of the urethra and bladder.

Keywords: Concentric Tube Robots; Minimally-Invasive Surgery; Natural Orifice Surgery; Transurethral Suturing.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
An illustration of the steps in our transurethral suturing concept. (A) Initially the needle arm pierces through the urethra and bladder, before (B) grasping the suture using a basket and then (C) pulling the suture through the bladder and then urethra walls. After this, (D) the manipulator arm grasps the suture and delivers it back into the bladder, in preparation for the next stitch. (E) An illustration of the final anastomosis from the endoscope’s point of view.
Fig. 2.
Fig. 2.
Top: Tube parameters for the robot arms used in the experiment; Bottom left: Close-up of the endoscope tip; Bottom right: Concentric tube robots prototype deployed through the endoscope.
Fig. 3.
Fig. 3.
Lens translation demonstration with corresponding endoscopic view (bottom row). The lens is translated toward the end effectors form left to right.
Fig. 4.
Fig. 4.
Experimental setup. Left: Endoscope view available for the surgeon; Right: Actuation unit carrying the endoscope inserted into the anatomical phantom model. Red arrows indicate manual actuated DoF for actuation unit motion. Orange arrow indicates the manual lens translation DoF.
Fig. 5.
Fig. 5.
Suturing Results. (A) The needle arm has pierced the urethra and bladder. (B1) The basket deployed from the needle and (B2) grasps the suture. (C) The suture is pulled through the wall of the bladder and then of the urethra. (D) The manipulator arm grasps the suture and returns its end to the bladder, in preparation for the next suture. (E) The final result. A complete anastomosis, seen from the endoscope’s viewpoint. (I-II) Views of the anastomosis from outside the bladder and urethra, showing the two attached to one another.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, and Jemal A, ”Cancer statistics 2020”, CA: A Cancer Journal for Clinicians, vol. 70, no. 1, pp. 7–30, 2020. - PubMed
    1. Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderäng U, Thorsteinsdottir T, Lagerkvist M, Damber J, Bjartell A, Hugosson J, Wiklund P, and Steineck G, “Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial”, European Urology, vol. 68, no. 2, pp. 216–225, 2015. - PubMed
    1. Humphreys MR, Sauer JS, Ryan AR, Leslie KO, Castle EP, Lingeman JE, and Andrews PE. ‘Natural orifice transluminal endoscopic radical prostatectomy: initial perioperative and pathologic results”, Urology, vol. 78, no. 6, pp. 1211–1217, 2011. - PubMed
    1. Humphreys M, Krambeck A, Andrews P, Castle E, and Lingeman J. “Natural orifice translumenal endoscopic surgical radical prostatectomy: Proof of concept”, Journal of Endourology, vol. 23, no. 4, pp. 669–675, 2009. - PubMed
    1. Krambeck AE, Humphreys MR, Andrews PE, and Lingeman JE. ‘Natural orifice translumenal endoscopic surgery: radical prostatectomy in the canine model”, Journal of endourology, vol. 24, no. 9, pp. 1493–1496, 2010. - PubMed

LinkOut - more resources