Robotic MRI/US fusion guided irreversible electroporation in intermediate-risk prostate cancer utilizing the Biobot Mona Lisa 2.0 platform

Objective We aim to report the first worldwide case of a patient undergoing prostate Nanoknife irreversible electroporation (IRE) focal therapy utilizing the Biobot Mona Lisa robotic platform (Biobot) to guide planning and treatment. Patients and Surgical Procedure A 64-year-old male presented with PSA of 4.1ng/mL underwent mpMRI which showed a 42g prostate and 6×4×6mm PIRADS-4 lesion with no evidence of extra-prostatic disease. Fusion biopsy revealed Gleason 3+4 prostatic adenocarcinoma. The patient elected to proceed with Biobot guided IRE. After general anesthesia was induced, a 16Fr foley catheter was placed and the patient was placed in dorsolithotomy position. The Biobot was docked at the perineum and the transrectal ultrasound (TRUS) probe was inserted. The base and apex were demarcated and the prostate was scanned. Using both surgeon guidance and artificial intelligence, the prostate was segmented. The uploaded mpMRI was fused to the TRUS scan. IRE electrode placement was planned with probes 9-22mm apart. Following planning, the Biobot positioned the multi-needle insertion guide along the trajectory of the electrode. Each electrode, set to the pre-planned exposure depth, was inserted through the insertion guide, with software sequentially planning electrode insertion medially to laterally, posteriorly to anteriorly, with real-time feedback allowing for less than 1 mm accuracy of electrode placement. The patient then underwent IRE using the Angiodynamics Nanoknife system. The foley was removed outpatient on postoperative day 5. Results There were no immediate or long-term postoperative adverse events or complications. The patient was discharged on the day of surgery. At 5-month follow up, the patient denied irritative voiding symptoms, PSA was 1.7 ng/mL and was awaiting future surveillance biopsy. Conclusions In conclusion, we report the first use of the Biobot in placement of electrodes IRE and demonstrate the step-by-step approach to robotic-guided electrode placement. Biobot allows for safe, precise, efficient placement of electrodes for IRE treatment, and shows promising early results.