Evaluating the Effectiveness and Safety of Robotic-Assisted MRI/TRUS Fusion Transperineal Prostate Biopsy Systems: A Narrative Review Based on Current Literature

Abstract

Robotic-assisted magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) fusion transperineal biopsy systems are one of the most debated and interesting subjects both in practice and in current urology literature. The comprehensive literature research was carried out in the PubMed/MEDLINE, Google Scholar, and Scopus databases using the terms “robotic transperineal prostate biopsy,” “robot-assisted MRI/US fusion biopsy,” “robot-assisted MRI/TRUS fusion biopsy,” or “robotic targeted prostate biopsies.” All article types were included in the study (n = 343). Among these, articles in non-English languages, duplicate articles, review articles, guidelines, and book chapters were excluded from the study (n = 325). Additionally, articles on In-bore biopsy and semirigid device techniques were also excluded from the study (n = 5). A total of 13 original research studies (3 retrospective and 10 prospective nonrandomized studies; total number of patients = 1844) performed with 2 different robotic-assisted transperineal biopsy platforms (iSR’obot™ MonaLisa, Biobot Surgical, Singapore; and Artemis™, Eigen,GRASS VALLEY, USA) were analyzed in detail. The overall cancer detection rates ranged from 51.2% to 73.7%, while the rates of detecting clinically significant (cs) prostate cancer (Pca) ranged from 23.0% to 52.7% in patients who had not been previously diagnosed with prostate cancer. Among the 1844 patients, only 2 individuals (0.01%) were diagnosed with urosepsis. Although the role of these devices in prostate biopsies is not completely clear, the robot-assisted transperineal prostate biopsy technique is an effective and safe procedure, with high rates of csPCa detection and acceptable rates of complications, especially in terms of urosepsis.