Institut des Systèmes Intelligents
et de Robotique

Title : Professor
Address : 4 place Jussieu, CC 173, 75252 Paris cedex 05
Email : vitrani(at)isir.upmc.fr
Group : AGATHE (AGATHE)

ROBUST 

ROBOTIC BIOPSY OF THE UTERUS STANDARDIZED TECHNIC

Technique standardisée pour la biopsie robotisée de l’utérus

Project Summary

Several studies and a FDA report clearly demonstrate the critical importance of a diagnosis tool allowing to differentiate benign and malignant tumours before a uterine minimally-invasive operation. The problem is, among the numerous diagnostic tools used by clinicians to evaluate women with tumour, none of them have been shown to reliably differentiate a malign from a benign tumour. Since any definitive diagnosis is based on pathologic examination, the gold standard is a uterine biopsy, to distinguish a malignancy from a benign condition, or between two different uterine tumours with different potential evolutions. However, there is no routine tool allowing to conduct sampling in the depth of the uterus.
The ROBUST project gathering an academic laboratory (ISIR), an innovative company (KOELIS) and a hospital (APHP LARIBOISIERE) is intended to provide a solution for this societal issue.

The proposed system will exploit state of the art in medical imaging and robotics to provide an innovative system allowing a secure, reproducible, and accurate sampling of the uterine mass. It will include a robotic system to position an ultrasound probe and the needle guide attached to it. A « co-manipulation mode » will be used to control a robotized probe holder. It will allow the surgeon to control the gesture as the robot and the surgeon simultaneously manipulate the ultrasound (US) probe. The gesture will be guided by ultrasound imaging using the latest developments in 3D and 4D reconstructions. In addition, a 3D cartography with accurate sample positions will allow the clinician an efficient interpretation of the biologic analysis of tissues.

ROBUST project investigates the scientific aspect of a recent approach for surgical robotics: the development of the image-based co-manipulated systems. The basic idea is to provide the surgeon with intelligent tools that help him/her only when necessary while letting him/her manipulating the tools. The specific contributions of the ROBUST project to this novel diagnosis procedure lead in the following items:

• First, the way of integrating the robot in the procedure is original by itself: the robot is a probe holder and a sensor to locate the probe for image processing.
• Second, image registration between MRI/US volumes and US/US volumes is a challenging research
• Finally, the development of image-based guidance for uterus is an open problem.

Consortium

Partners’ complementarity

The competences of the project partners are very complementary and cover every scientific and technical aspect of the project, which should result in a high probability of success. All parts of the project are intimately linked, making ROBUST a fully collaborative project bringing together: an academic laboratory which concern is robotic systems for gesture assistance; a clinical partner having experiences in the field of clinical validation of new technologies and expertise in minimally invasive surgery for gynaecology; a French start-up company specialized in image-guided surgical systems.

Two communications based on this project and involving the 3 partners were presented in 2016:

• Fazel, A. Vitrani, MA. Gaudard, E. Baumann M. Robotic Biopsy of the Uterus Standardized Technique (ROBUST): A New Technique for Uterine Biopsy Prior to Minimally Invasive Surgery. ESGE 25th annual Congress 2016.
• Fazel, A. Vitrani, MA. Gaudard, E. Baumann M. Robotic Biopsy of the Uterus Standardized Technique (ROBUST): A New Technique for Uterine Biopsy Prior to Minimally Invasive Surgery. Journal of Minimally Invasive Gynecology 23 (7), S227-S228

ISIR

The research laboratory involved in ROBUST is the Institute for Intelligent Systems and Robotics (ISIR, headed by Raja Chatila), which is the largest research laboratory solely dedicated to robotics in France, with double affiliation to UPMC and CNRS (National Centre of Scientific Research, UMR 7222). AGATHE (Assistance to Gesture with Application to THErapy) is one of the four research teams in ISIR and is also affiliated to INSERM (National Institute for Health and Medical Research, U1150, headed by Guillaume Morel). Within AGATHE, the research concerns the design and control of robotic devices aimed at assisting human movements. They are finalized towards two kinds of applications: “Assistance to medical and surgical interventions” and “Assistance to patients suffering from a motor impairment”.

Koelis

Koelis is an innovative French company based in Grenoble, employing 35 people, actively growing, and working mainly with local employees and subcontractors. It is an international leader of computer-assistance systems in urology. Koelis is the creator of the Urostation®, an innovative device able to perform a 3D mapping of prostate biopsies with multimodal images fusion (patented technology). More than one hundred systems are used in the world. The Trinity® platform recently launched increases the functions of the Urostation® by advantageously integrating 3D ultrasound means. The proposed system for assisted uterus biopsies represents a natural extension of its existing product range. Koelis has coordinated the ANR TecSan project PROSPER for robot-assisted brachytherapy, and the ANR TecSan project PROSBOT for a robotic endocavitary ultrasound probe holder as well as prostate puncture simulation for educational purposes.

Hopital Lariboisière

The Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, APHP, is one of the major University hospitals located in the heart of Paris. This institution is cited 31 times among the top 50 best institutions in France. The very first Uterine Artery Embolization was performed in this institution in 1989. With over 3000 fibroids treated since 2002 and being an official expert center in oncology recognized by the National Authorities (InCa), the department of OBGYN is one of the leaders in treating both benign and malignant tumours.