2392 ROBUST (Robotic Uterine Standardized Techniqueor): A Novel System for Uterine Biopsy

Abstract

Study Objective The differential diagnosis of fibroids could be challenging with other uterine masses including adenomyomas or uterine cancers and sarcomas. Minimally Invasive procedures including morcellation mandates a thorough imaging and if possible histologic analyses. To date such a pathologic approach has a very poor accuracy, even conducted under ultrasound, MRI or hysteroscopic guidance. A targeted biopsy requires the development of state of the art imaging and robotics to enable a secure, reproducible, and accurate sampling. The aim of our study is to develop such a device based on the latest innovations in 3D imaging and robotics. Design ROBUST includes a robotic system called APOLLO® to position an ultrasound probe and an needle attached to it. A «co-manipulation mode » is used to control a robotized probe holder with Trinity, a 3D Ultrasound System performing image fusions. Setting University Hospital and University Research Laboratory in Robotics Patients or Participants Phantom Model Interventions Numerical approach on a phantom to estimate the interaction between the probe tip and the insertion environment. It is implemented on a robotic control law in order to accurately position the probe tip on uterine target Measurements and Main Results Biomechanical study of the uterus were performed to ensure the robustness and the efficacy of the image fusion. The fusion between intraoperative US images will allow the tracking of the organ displacement and deformation. A graphical interface dedicated to uterus diagnosis and puncture accessories will be developed. The guidance of the clinician gesture through a co-manipulated mode will allow an optimized targeting, exploiting the MRI targets of the imaging system, and taking account of the anatomical limits with a force feedback system Conclusion Two experiments manipulating Freely an ultrasound probe along two perpendicular translation and after insertion in an anatomical phantom helped us to assess a mathematical model to improve a robotic device to direct ultrasound guided biopsies.