title: Toward Improving Transurethral Prostate Surgery: Development and Initial Experiments with a Prototype Concentric Tube Robotic Platform.
abstract: Despite the potential clinical advantages of holmium laser enucleation of the prostate (HoLEP), there has been reluctance of the urologic community to adopt the procedure, as a result of a perceived steep learning curve. Thus, we sought to design and develop a transurethral endoscopic robotic platform for HoLEP.
  
  
  
  We developed a novel transurethral, concentric tube robotic platform for HoLEP. We conducted magnetic tracking experiments to compare movements of the end effectors of the robot with those of a rigid endoscope. Additionally, we tested the robot on an HoLEP simulator and with a human cadaveric prostate to assess its ability to maneuver within a small working space.
  
  
  
  In the prostate scanning experiment, the area reached by the robot represents a 65% improvement vs the area accessible by a rigid endoscope without tissue deformation. Additionally, the robot performed well within the confines of the prostatic urethra and was able to successfully complete prostate lobe enucleation, on both the HoLEP simulator and with a human cadaveric prostate.
  
  
  
  We have developed a concentric tube robotic platform that is passed through a standard endoscope that is capable of producing complex movements of the end effectors. We have shown that these movements of the concentric tube manipulators are capable of performing tasks that may eventually translate into improved ease of performing HoLEP.
authors.affiliation: 1 Department of Urology, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mitchell
authors.affiliation: 2 Department of Mechanical Engineering, Vanderbilt University , Nashville, Tennessee.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hendrick
authors.affiliation: 2 Department of Mechanical Engineering, Vanderbilt University , Nashville, Tennessee.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Webster
authors.affiliation: 1 Department of Urology, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
mesh_terms: D002102:Cadaver; D004724:Endoscopy; D006695:Holmium; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D053844:Lasers, Solid-State / Q000627:therapeutic use; D059032:Learning Curve; D008297:Male; D011470:Prostatic Hyperplasia / Q000601:surgery*; D065287:Robotic Surgical Procedures; D020728:Transurethral Resection of Prostate / Q000295:instrumentation* / Q000379:methods*; D013520:Urologic Surgical Procedures
chemical_list: D006695:Holmium