Prostate Biopsy Robot: From MRI Fusion to ABB Labs

A prostate biopsy robot has one narrow job. It holds and aims a needle so a urologist can take tissue from the exact spot an MRI scan flagged. For most of the last century that aim came from a finger in the rectum, and later from a freehand ultrasound probe. This post follows prostate biopsy from open surgery in 1926 through ultrasound guided sextant sampling and MRI fusion to robotic transperineal systems such as the iSR'obot Mona Lisa. The later sections cover recent news, where ABB robots fit around the procedure, and the unsolved problems of cost, training and access.

A patient enters an MRI scanner at Narayana Multispeciality Hospital in Jaipur, India, 2015. Photo: GeorgeWilliams21 / Wikimedia Commons (CC BY-SA 4.0)

Needles guided by a finger and then by ultrasound

The first prostate biopsy, in 1926, was an open operation through the perineum. Patients needed general anaesthesia and a week in hospital, and most were left with incontinence and erectile problems. Needle methods came next. In 1937 Astraldi described a finger guided biopsy through the rectum, and in 1954 Kaufman introduced finger guided aspiration through the perineum: the needle went into the skin about a centimetre above the anus while a finger in the rectum steered it. The doctor was feeling for a hard nodule and could only hope the needle reached it.

Stanley Boyd about to operate in the old operating theatre at Charing Cross Hospital, London, around 1900, the era of open surgery. Photo: Wellcome Collection via Wikimedia Commons (CC BY 4.0)

Transrectal ultrasound let doctors see the gland. Takahashi and Ouchi first used it on the prostate in the 1960s, but their images were too poor for clinical use. In 1974 Watanabe and colleagues produced the first clinically useful pictures with a 3.5 MHz probe. Then in 1989 Hodge and colleagues described the first practical ultrasound guided biopsy along with the sextant scheme, six cores taken from the base, middle and apex of each side. Once PSA blood tests became common, this systematic freehand transrectal biopsy became the standard check for men with a raised PSA.

Nurses prepare an ultrasound examination at Laquintinie Hospital in Cameroon, 2021. Photo: Max Mbakop / Wikimedia Commons (CC BY-SA 4.0)

Six or twelve cores taken in a fixed pattern can miss a small tumour and pick up harmless ones, and a needle passed through the rectum carries bacteria into the gland. MRI helped with the first problem by showing a suspicious area before any needle goes in. Fusion systems then laid the MRI over the live ultrasound image so the doctor could aim at that area. Robotic guidance appeared in the same period. The original Biobot needle guide, a computer assisted device for transperineal biopsy under ultrasound, received United States 510(k) clearance in August 2011.

Stained and mounted tissue slides in a 20 slide folder, the form in which biopsy cores reach the pathologist. Photo: Ed Uthman / Wikimedia Commons (CC BY-SA 2.0)

MRI first, then a robot to place the needle

In the United States, scanning first has become the usual route. A study in JAMA Oncology, reported in September 2026, looked at more than 505,000 prostate biopsies at United States hospitals between January 2017 and June 2026, using the Epic Cosmos records database. In the first half of 2026, 64% of men having their first biopsy had an MRI beforehand, up from 14% in 2017. About a third still had no scan, a gap the University Hospitals team linked partly to access and insurance coverage.

A mobile MRI scanner unit parked at the Royal Stoke University Hospital, England, 2014. Photo: Jonathan Hutchins / geograph via Wikimedia Commons (CC BY-SA 2.0)

Once the target is known, a robot can help reach it. Biobot Surgical's iSR'obot Mona Lisa 2.0, cleared by the FDA in 2022, is a robotic needle guidance system for transperineal biopsy and ablation. It fuses MRI with ultrasound, plans needle positions automatically and can adjust a target when the needle deflects. Its dual cone trajectory lets several cores be taken through the same entry point in the skin. The transperineal route passes through the skin between the legs and avoids the rectum, and Biobot says this gives lower infection rates and better coverage of the front of the gland than transrectal biopsy.

A medical examination room with an ultrasound machine beside the couch, 2025. Photo: Shixart1985 / Wikimedia Commons (CC BY 2.0)

ABB does not make biopsy robots, and none of its arms is cleared for use on patients. Where ABB robots could matter is in the work around the procedure. ABB set up a healthcare research hub in Houston to develop robots for hospital laboratory work, and the lab is where biopsy cores go next, to be labelled, fixed, embedded and cut for the pathologist. A cobot such as the GoFa CRB 15000 could possibly handle cassettes and slides in that chain. ABB robots also work in medical device manufacturing, the industry that builds needle guides and probes.

A GoFa cobot at ABB's healthcare research hub. Photo: ABB

What comes next for robotic biopsy

The next step is pairing better imaging with automatic needle placement. Newer scans such as PSMA PET are being tested for guiding biopsies, and AI tools are being trained to read prostate MRI and help decide who needs a biopsy at all. A robot that can take a target from any of these images and place the needle accurately fits naturally into that chain. Whether biopsies move to smaller clinics under local anaesthetic will depend on cost and training at least as much as on the machines.

A pathologist at a microscope, 1989. Biopsy cores still end up under a microscope like this. Photo: Bill Branson, National Cancer Institute via Wikimedia Commons (public domain)

The randomized trials behind MRI first biopsy showed that scanning and then targeting finds more aggressive cancers, and robotic guidance is meant to make that targeting more repeatable. Robotic systems cost more than a freehand needle guide, though, and a hospital has to justify the purchase against the number of men it tests. Access is the other problem. The JAMA Oncology study found that a third of first biopsies still skip MRI, and a robot cannot help a man who never had the scan.

ABB's mobile YuMi concept loading a centrifuge in a hospital laboratory. Photo: ABB

Engineers face problems that are familiar from other surgical robots. Images have to be registered to a patient who breathes and shifts, needles bend in tissue, and every claim of safety has to satisfy regulators. Industrial arms such as ABB's have no place in that clinical market today. They are more likely to show up before and after the procedure, building devices in clean rooms and handling samples in pathology labs, and ABB's robot use cases include similar lab and medical work.

ABB's mobile YuMi concept, a dual arm robot on a wheeled base, in a hospital lab corridor. Photo: ABB

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