タルサ術中に何が起こるか

タルサ術は、次の4つの段階で構成されます。

1. 準備

手術前に、患者は治療チームと面会します。 通常、治療チームには、治療担当 医師(泌尿器科医および/または放射線科医)、麻酔科医、および放射線技師が 参加します。 治療チームは、鎮静前に患者が落ち着いているかを確認します。

その後、患者はMRI室に移動し、超音波アプリケータ(UA) が尿道に挿入さ れ、直腸内冷却装置(ECD)が、担当医によって直腸に挿入されます。

UA には10個のトランスデューサ要素があります。 それぞれが超音波エネルギー を前立腺に放出します。 医師は、前立腺の大きさに応じて、各トランスデュー サ要素を個別に起動および制御できます。 以下の例では、目的の前立腺組織をターゲットにするた めに必要なトランスデューサ要素は10個のうち9個だけです(図1)

図1:超音波アプリケーター(UA)

ECDは、熱超音波エネルギーから直腸組織を保護する受動冷却装置であり、患者 の自然な機能を維持するのに役立ちます(図2)。 CDから放出されるエネル ギーはありません。

こうした装置が患者に挿入されると、治療チームとして計画段階の準備が整い ます。

図2:直腸内冷却装置(ECD)

2. 計画

The TULSA-PRO system is connected to the MRI machine (Figure 3). This enables the physician to use high-precision MR imaging to determine the exact areas of the prostate that will be ablated. Using these MR images, the physician draws out the boundary lines to create the patient’s customized procedure plan, tailored to their individual prostate shape, size and disease, while avoiding important nerve bundles and critical structures around the prostate.

Figure 3: The TULSA Procedure is delivered to the patient by connecting the MRI system with the TULSA-PRO system, which allows the treating physician to use high-precision MR images to clearly see the prostate and draw the appropriate ablation boundary lines around the prostate tissue.

Using high-precision MR imaging, the physician can see the prostate in the axial view (Figure 4a), sagittal view (Figure 4b), and coronal view (Figure 4c). Using these images, the treating physician draws the boundary lines around the prostate section that corresponds to each ultrasound element. For example, in Figure 5, a specific ablation boundary line is drawn for transducer element 4.

Figure 4: The prostate anatomy in the a) axial view, b) side view, and c) coronal view.

Figure 5: The Ultrasound Applicator (UA), the Endorectal Cooling Device (ECD) and the boundary line for Transducer Element 4 in the a) axial, b) sagittal, and c) coronal view.

If the physician is preparing for a whole-gland ablation, they will continue to draw separate ablation boundary lines for the rest of the transducer elements, until the entire targeted prostate tissue region is selected (Figure 6).

Figure 6: Boundary lines for a whole-gland ablation procedure, with transducer elements 1-9 activated, in the a) axial, b) sagittal, and c) coronal view.

If the patient receives a partial gland ablation (for example a hemi ablation), the treating physician can customize the ablation area by drawing boundary lines around only sections of the prostate, and for only a subset of the transducer elements (Figure 7).

Figure 7: Boundary lines for a hemi ablation procedure, with transducer elements 1-5 activated, in the a) axial, b) sagittal, and c) coronal view.

Some patients may be suitable for a nerve sparing plan, and the treating physician can accommodate this using the TULSA Procedure. The treating physician would adjust the ablation boundary lines so they are further away from the neurovascular bundles (Figure 8).

Figure 8: Boundary lines for a nerve sparing procedure, with transducer elements 2-9 activated, in the a) axial, b) sagittal, and c) coronal view.

The treating physician has the control and flexibility to adjust each boundary line depending on the patient’s anatomy (size and shape of prostate), their needs, and where the diseased prostate tissue is.

Now that the boundary lines have been drawn, the treatment team is now ready to begin prostate ablation.

3. 送達

During prostate ablation, the UA rotates within the urethra, creating a sweeping heating pattern that is directional and ablates the prostate tissue using an inside-out approach.

During the procedure, the TULSA-PRO system automatically carries out the ablation instructions outlined by the physician, ablating only within the prescribed boundary lines using real-time thermal images. The TULSA-PRO system carries out the physician’s treatment plan, which helps ensure precise prostate ablation and minimizes the risk of human error.

Figure 9: In this whole gland ablation, the physician can see the areas of the prostate being ablated in the a) axial view, b) side view, and c) coronal view.

Figure 10: In this hemi ablation, the physician can see the areas of the prostate being ablated in the a) axial view, b) side view, and c) coronal view.

TULSA PRO’s connection to the MRI machine creates a closed-loop thermal feedback system and allows for the physician to see MRI thermometry images in real-time. The real-time MRI thermometry images show the changing temperature of the prostate tissue and surrounding structures every 6 seconds. This visibility allows the physician to actively monitor tissue heating and make changes to the treatment delivery if necessary, making the TULSA Procedure controlled and predictable.

Once ablation is complete, the physician can always go back and deliver additional ablation to the prostate if necessary.

Figure 11: In this nerve sparing ablation, the physician can see the areas of the prostate being ablated in the a) axial view, b) side view, and c) coronal view.

4. 確認

Using MR imaging, the physician will confirm the intended areas of the prostate that have been ablated successfully. Once the TULSA Procedure is complete, the patient will be catheterized and monitored during a brief recovery period. Patients are typically able to leave the same day, and resume daily activities.

Figure 12: Magnetic Resonance (MR) Images of a prostate a) before, and b) immediately after the TULSA Procedure.

ご質問がありましたら、 お問い合 わせ

タルサ術について質問がある場合は、TULSA-PRO専門センターに連絡するか、 Profound Medicalまでお問い合わせください。

お問い合わせ

最新情報を入手

すべての年齢とステージに関する最新のヒントを入手しましょう。ニュースレターをご購読ください。
ニュースレターを購読