Introduction:

Irreversible Electroporation (IRE) is an emerging modality of focal therapy in patients with low to intermediate risk prostate cancer. Using a needle gridplate or freehand approach, 2-6 electrodes are placed in parallel 9-22 mm apart, bracketing the lesion. The correct spacing, orientation, and positioning of electrodes is paramount to treatment success. The Biobot Mona Lisa robot has been increasingly studied as a robotic method for transperineal prostate biopsies. Offering both planning software and robotic precision, the Mona Lisa system allows for optimized targeted needle placement. Mona Lisa 2.0 has recently been adapted for transperineal percutaneous ablation guidance. We aim to describe the first reported prostate focal therapy utilizing the Mona Lisa robot to guide Nanoknife IRE planning and treatment.

Methods:

Candidates for focal therapy with IRE were selected and consented. General anesthesia was obtained, a foley catheter was placed, and patients were positioned in dorsal lithotomy. The Mona Lisa system was docked, and the prostate was mapped in its entirety using transrectal ultrasound with the Mona Lisa software. Previous MRI imaging was fused with the real time ultrasound, and electrode placement was planned using Mona Lisa software for focal therapy guidance, as to optimize depth, distance between probes, rectum, urethra, and optimal coverage of the lesion. Employing real-time needle deflection adjustment, IRE electrodes were sequentially placed through the needle guide with meticulous precision. Placement was confirmed in sagittal and axial planes, allowing for < 1 mm accuracy of probe placement, a significant improvement over standard gridplate approaches. IRE treatment was performed with the Nanoknife system as previously described. Patients were managed according to prescribed institutional protocol, with QOL outcomes recorded.

Results:

In total, 10 patients have undergone IRE with Mona Lisa assisted placement of electrodes at our institution from 12/2025 until 7/2025. Patients have tolerated the procedure well, with mean operative time of 99 minutes, and no periprocedural complications related to the use of the Mona Lisa or IRE treatment.  Short and intermediate risk QOL outcomes are being compiled for analysis but are reflective of previously published reports.

Conclusion:

We describe the first use of the Biobot Mona Lisa robot to guide probe placement and treatment for prostate IRE focal therapy. Mona Lisa allows for safe, precise, pre-planned, efficient placement of electrodes for IRE treatment, and shows promising early results.

Funding: N/A