Transperineal prostate biopsy: Freehand technique using Trinity system

The video above, as well as videos from Amir H. Lebastchi, MD, Luke O’Connor, PhD, and Peter A. Pinto, MD;and Arvin George, MD, illustrate techniques for performing transperineal prostate biopsy. Commentary on the videos is provided by Lebastchi, clinical fellow in urologic oncology, Urologic Oncology Branch, National Cancer Institute, Bethesda, MD.

Lebatschi: Abreu’s group at USC provides an overview of the transperineal MRI/TRUS fusion prostate biopsy also utilizing the freehand technique. While the Trinity system provides the capability to perform the transperineal biopsy utilizing a needle-guide and probe holder, the authors prefer performing the technique freehand. After advancing a coaxial needle toward the apex through the ipsilateral side of the perineum, a biopsy needle is inserted and a virtual biopsy is performed first. Once the virtual biopsy hits the target, a reference image is taken. Under TRUS guidance, a real-time image matches the reference image, and the biopsy gun is fired. Trajectories are tracked to confirm whether the targets are adequately sampled. Following the targeted biopsies, the USC team routinely performs a standard systematic biopsy.

Abreu is assistant professor, Institute of Urology, University of Southern California, Los Angeles.

'Y'tube Section Editor James M. Hotaling, MD, MS, is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.