Name:
Freehand Transperineal Prostate Biopsy
Description:
Freehand Transperineal Prostate Biopsy
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/c7a5b926-5cac-4c9a-85bf-d0d2866640c4/videoscrubberimages/Scrubber_0.jpg?sv=2019-02-02&sr=c&sig=hBwSG7YayujOejPxl9m6Xf3T7d%2BP3%2BH3nJ81BXiNIP8%3D&st=2024-04-25T11%3A12%3A15Z&se=2024-04-25T15%3A17%3A15Z&sp=r
Duration:
T00H04M50S
Embed URL:
https://stream.cadmore.media/player/c7a5b926-5cac-4c9a-85bf-d0d2866640c4
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/c7a5b926-5cac-4c9a-85bf-d0d2866640c4/Freehand Transperineal Prostate Biopsy.mp4?sv=2019-02-02&sr=c&sig=7mvqL3ZjQZ7I9vgRG10io2cC%2BvvagaSn4lPI3R1k7NY%3D&st=2024-04-25T11%3A12%3A15Z&se=2024-04-25T13%3A17%3A15Z&sp=r
Upload Date:
2023-10-19T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 INTRODUCTION.
SPEAKER: Freehand Transperineal Prostate Biopsy with Three-Dimensional Ultrasound Organ-based Tracking-- "Preparation of Pre-biopsy MRI Images." Prior to the procedure, the patient's MRI images are contoured and segmented on the MrDraw workstation. This includes separate segmentation of the gland itself and any regions of interest. Once the images have been prepared and a 3D representation of the prostate has been rendered, the MRI images are transferred from the MrDraw workstation to the Trinity biopsy platform.
Segment:2 DEVICE AND ULTRASOUND SET-UP.
SPEAKER: "Setup of the Ultrasound Probe and PrecisionPoint Transperineal Access System." The PrecisionPoint Transperineal Access System is a sterile, single-use, disposable, needle guide comprised of three components-- a rail clamp subassembly, a needle carriage with five aperture holes, and a 15-gauge access trocar. Prior to use, the device is assembled by the user and attached to the ultrasound probe.
SPEAKER: To prevent rotation of the device on the ultrasound probe, a piece of Coban wrap may be first applied to the neck of the probe. Alternatively, a custom-made, 3D-printed adapter may be used for this purpose at the discretion of the physician.
Segment:3 PROBE INSERTION.
SPEAKER: "Ultrasound Probe Insertion." Prior to ultrasound probe insertion, 30 milliliters of ultrasound jelly is instilled inside the rectum using a Toomey-style syringe.
SPEAKER: The ultrasound probe is next gently inserted into the rectum, and positioned against the anterior rectal wall.
Segment:4 LOCAL ANESTHESIA ADMINISTRATION.
SPEAKER: The "Administration of Local Anesthesia." The first step in anesthesia administration is infiltration of the skin at the sites of eventual placement of the access trocar. This is determined by rotating the probe to the outer one third of the gland bilaterally, and marking the overlying skin with a linear line at the same angle as the probe's rotation.
SPEAKER: A wheal is raised in the skin along the length of each marking using lidocaine. A spinal needle is next passed through the access trocar and into the deeper tissue of the perineum under ultrasound guidance. Lidocaine is injected continuously with needle passage along a linear tract extending from the puncture site to the apex of the prostate. Great care is taken to ensure adequate administration of the local anesthetic at the level of the levator ani muscles.
SPEAKER: Once these muscles have been anesthetized, the spinal needle is used to puncture beneath the endopelvic fascia. And a bolus of lidocaine is administered in the potential space at the apex of the gland.
Segment:5 REFERENCE ULTRASOUND ACQUISITION.
SPEAKER: "Reference Ultrasound Acquisition." After the local anesthesia is administered, a reference 3D ultrasound scan of the prostate is acquired. The scan is presented to the user as scrollable images in the axial, sagittal, and coronal planes of view.
SPEAKER: The reference ultrasound scan is next contoured and segmented to create a 3D reference volume of the prostate.
Segment:6 FUSION OF THE MRI AND ULTRASOUND IMAGES.
SPEAKER: "Confirmation of MRI/Ultrasound Fusion." Once the 3D ultrasound sweep has been acquired, fusion is performed between the reference and MRI volumes using elastic registration. The user then confirms the adequacy of image registration. And if confirmed, the locations of any MRI targets are transferred onto the reference volume.
Segment:7 INSERTION OF THE ACCESS TROCAR.
SPEAKER: "Insertion of the Access Trocar." To begin obtaining cores of the prostate, the access trocar is engaged into the perineal skin at one of the previously anesthetized sites.
Segment:8 BIOPSY PERFORMANCE.
SPEAKER: "Biopsy Performance with MRI Targeting." The ultrasound probe is rotated and pointed from the fulcrum point of the access trocar until the user has a reasonable degree of certainty that the MRI target is located within the ultrasound's plane of view.
SPEAKER: A biopsy of the tissue may be obtained, or an updated 3D ultrasound acquired. In the latter case, the new 3D ultrasound is fused back to the reference scan, and a virtual needle core is presented on the 3D volume of the prostate. The user can then determine if the biopsy should be performed, and at what height and angle the needle needs to be navigated to hit the target.
SPEAKER: Once the biopsy gun has been fired, the needle is left in place. And an updated 3D ultrasound is acquired. The location of the real biopsy core is next recorded on the reference volume. These same steps are repeated for each throw of the needle. And as the procedure progresses, the location of each of the obtained biopsy specimens appears on the reference volume of the gland.
SPEAKER: This information allows the user to ensure adequate sampling of the gland with even spacing between cores.
Segment:9 POST BIOPSY CASE REVIEW.
SPEAKER: "Post-biopsy Case Review." Once the procedure is completed, the reference ultrasound and 3D volume containing the locations of any regions of interest in biopsy cores can be sent to the MrDraw workstation or other PACS system for review.
SPEAKER: Here, the reference ultrasound was fused to the pre-biopsy MRI. And the target along with the biopsy cores are superimposed on the T2 MRI.