The current biopsy procedure is to introduce a needle inside the patient towards a given target using echography imaging for control of the position. Reaching the target at the right position is a real issue for diagnosis, therapy and also prognosis, for example concerning tumors or abscess. The NOCT project aims at developing two apparatus, one for imaging and one for navigation, integrated in a complete clinical application of real-time echography navigated biopsy, which would be the first of its kind in the world. We will build an optical imaging system with a needle-like probe that could perform virtual “optical biopsy” prior to the excision of the sample by revealing in vivo the fine microstructures of the tissue. Full-Field OCT is the best-suited technique for this purpose. This technology is now commercialized in a microscope for ex vivo imaging, and we plan on adapting it in a system with a thin rigid probe, with emphasize on ergonomic constraints such as the diameter and length of the needle. We will create a precise surgical navigation system that will be adapted to the clinical ambulatory context, so that it would become in the next decade a reference system for computer assisted medical interventions. This project is a translational research between physics, informatics and medicine, where a key point is to adapt novel technologic apparatus to specific clinical needs. With the aim of the future clinical application we will characterize the preclinical and clinical performance and pay attention on risk management and authorization from the CPP, ANSM and HAS. We will meet these challenges as a consortium of five partners: two laboratories specialized in optics and in computer assisted medical interventions, Institut Langevin-ESPCI and TIMC-IMAG, one clinical investigation center specialized in interventional radiology and computer assisted medical interventions, CIC-IT, and two private companies that will industrialize the final resulting systems, LLTech and Surgiqual Institute.

Surgical treatment of prostate cancer (one of the first cause of mortality by cancer in men) is in mutation with the introduction of robotic systems in the operating room (such as the da Vinci® telesurgery system or the ViKY® endoscope holder). However, robot assisted procedures do not exploit endo-urethral or fluorescence imaging yet, though they would allow the surgeon to “see beyond the visible”, helping him to perform his gesture optimally. These new per-operative imaging modalities are impatiently awaited by surgeons in order to bring pertinent therapeutic response to the surgical treatment of prostate cancer, a real Public Health problem doomed to increase in the future years. DEPORRA2 aims at demonstrating that we can offer the surgeon, the possibility to explore per-operatively the prostatic tissue, through an “augmented” robotic environment, by enriching the laparoscopic images with endo-urethral ultrasound imaging and with mini-camera imaging. DEPORRA2 is a “follow-up” project, in continuity with the DEPORRA project, in which we demonstrated our capacity to conceive and develop: 1) Miniature tools adapted to the radical prostatectomy problematic: flexible intraurethral ultrasound probe and associated software, bimodal fluorescence probe for the detection of the nature (prostatic / non prostatic) and quality (malignant / non malignant) of dissected tissue, stereoscopic “global vision” system; 2) Registration methods for the fusion of this multimodal information in an enriched robotic environment in view of offering the surgeon an exhaustive view of the surgical environment, based on which he will be able to undertake strategic per-operative decisions. We now need to change dimension and maturate these innovations towards medical devices ready for clinical validation. This will go through: 1) Putting in place harmonious software and navigation procedures guiding the surgeon in the realization of his gesture (e.g. avoid structures whose damage can induce a degradation of the quality of life) 2) Enhancing the most "mature" technological bricks of DEPORRA to bring them closer to clinical constraints (this will require a pushed evaluation on pre-clinical and clinical data that are currently gathered through running biomedical protocols). The less mature fluorescence characterization aspects have been removed from this follow-up project but are adressed in another running project (AAP INCA "translational research"). 3) The preparation of biomedical research in order to make a first estimation of the delivered medical service of the proposed innovations. A consortium of experts has been consituted to take up these challenges: Vermon brings its capacity to miniaturize and to dedicate ultrasound devices to the navigation of prostatic tissue; TIMC-IMAG/DyCTIM brings its expertise in the field of fluorescent tracers of the tissue nature, SQI brings its know-how in the development and risk analysis of medical devices (software + hardware). TIMC-IMAG/CAMI has a long experience in the conception and integration of multimodal systems for Computer Assisted Medical Interventions. Finally the Centre d’Investigation Clinique – Innovation Technologique of the Grenoble University Hospital brings, with its clinical partners, the environment for the support of (pre-)clinical validation of the prototypes. At the end of this industrial research project, we will have all the scientific, technical and clinical elements to make a high-stake product. DEPORRA2 will reinforce the position of complementary and highly specialized industrial actors, Vermon and SQI, by generating a niche line of business in the urology market thanks to an extremely innovative approach.