A multi-arm hand-held robotic system for transurethral laser Prostate surgery

Benign prostatic hyperplasia is the most common symptomatic disease in men. A new transurethral surgical intervention is available that has been shown to reduce bleeding, catheterization time, and hospitalization time in comparison to traditional Transurethral Resection of the Prostate (TURP). However, this new procedure, Holmium Laser Enucleation of the Prostate (HoLEP), is so challenging to accomplish that only a small number of expert surgeons are able to offer it. Toward facilitating broader use of HoLEP, we propose a new hand-held robotic system for the purpose of making the surgery easier to perform. In current HoLEP, the only way to aim the laser and/or manipulate tissue is to move the entire endoscope, stretching a large quantity of tissue. In contrast, our new robotic approach provides the surgeon with two concentric tube manipulators that can aim the laser and manipulate tissue simultaneously. The manipulators are deployed through a 5 mm working channel in a 26 French (8.66 mm) endoscope clinically used for transurethral procedures. This paper describes the design of the robot and experiments illustrating its ability to perform the motions expected to be useful in HoLEP.