Freehand transperineal prostate biopsy under local anesthesia using a novel needle guide system with angle-adjustment feature.

overviewFreehand transperineal prostate biopsy (TPPB) needle guides are designed to maintain a parallel alignment between the co-axial introducer needle and the ultrasound (US) transducer. However, this parallel alignment necessitates transducer angulations within the patient's rectum for sampling anterior or posterior regions of the prostate, which introduces several problems both for the patient and the operator. This article introduces a technique using a TPPB needle guide system with a novel angle-adjustment feature, which minimizes intrarectal transducer movements.

objectivesFreehand TPPB typically requires anterior or posterior angulation of the ultrasound (US) transducer, which leads to prostate compression, increased patient discomfort, reduced sonographic image quality, and challenges in MRI-ultrasound fusion biopsy registration. To address these issues, a novel TPPB needle guide system (PERINO-FLEX) featuring a co-axial needle angle adjustment mechanism has been introduced. The system includes a rotating component through which the coaxial needle passes, enabling up to 45 degrees of anterior or posterior angulation within the perineum, without the need to angulate the intrarectal US transducer. In this article, we aim to describe the TPPB technique utilizing this unique angle-adjustment feature and to highlight its advantages.