Robotic Transurethral Vesicourethral Anastomosis after Radical Prostatectomy in Validated Models

Area of Science:

• Urology
• Robotic Surgery
• Medical Devices

Background:

• Minimally invasive techniques in radical prostatectomy enhance patient recovery.
• Transurethral prostatectomy aims to reduce surgical dissection but faces challenges in vesicourethral anastomosis.
• Limited instrumentation hinders reliable anastomosis after transurethral prostatectomy.

Purpose of the Study:

• To develop and evaluate a concentric tube robot (CTR) system for transurethral vesicourethral anastomosis.
• To address the limitations of current instrumentation for anastomosis after transurethral prostatectomy.
• To enable a natural-orifice approach to radical prostatectomy.

Main Methods:

• A novel CTR system with needle-sized robotic arms was constructed for transurethral surgery.
• The CTR system utilizes telescoping, curved, elastic tubes for suturing within the urethra.
• System performance was evaluated in validated phantoms for vesicourethral anastomosis after transurethral radical prostatectomy.

Main Results:

• Transurethral radical prostatectomy and anastomosis were performed in 11 phantoms.
• A successful vesicourethral anastomosis was achieved in 10 out of 11 (91%) experiments.
• Median resection time was 19 minutes, and median suturing time was 103 minutes.

Conclusions:

• The CTR system successfully enabled transurethral vesicourethral anastomosis in phantom models.
• This robotic system overcomes a key barrier to natural-orifice radical prostatectomy.
• The CTR facilitates intraluminal completion of the vesicourethral anastomosis.