Introduction: This study focuses on the quantification of and current guidelines on the hazards related to needle positioning in prostate cancer treatment: (1) access restrictions to the prostate gland by the pubic arch, so-called Pubic Arch Interference (PAI) and (2) needle positioning errors. Next, we propose solution strategies to mitigate these hazards. Methods: The literature search was executed in the Embase, Medline ALL, Web of Science Core Collection*, and Cochrane Central Register of Controlled Trials databases. Results: The literature search resulted in 50 included articles. PAI was reported in patients with various prostate volumes. The level of reported PAI varied between 0 and 22.3 mm, depending on the patient’s position and the measuring method. Low-Dose-Rate Brachytherapy induced the largest reported misplacement errors, especially in the cranio-caudal direction (up to 10 mm) and the largest displacement errors were reported for High-Dose-Rate Brachytherapy in the cranio-caudal direction (up to 47 mm), generally increasing over time. Conclusions: Current clinical guidelines related to prostate volume, needle positioning accuracy, and maximum allowable PAI are ambiguous, and compliance in the clinical setting differs between institutions. Solutions, such as steerable needles, assist in mitigating the hazards and potentially allow the physician to proceed with the procedure. This systematic review was performed in accordance with the PRISMA guidelines. The review was registered at Protocols.io (DOI: dx.doi.org/10.17504/protocols.io.6qpvr89eplmk/v1).

Needles are commonly used in medical procedures. However, current needle designs have some disadvantages. Therefore, a new generation of hypodermic needles and microneedle patches drawing inspiration from mechanisms found in nature (i.e. bioinspiration) is being developed. In this systematic review, 80 articles were retrieved from Scopus, Web of Science, and PubMed and classified based on the strategies for needle-tissue interaction and propulsion of the needle. The needle-tissue interaction was modified to reduce grip for smooth needle insertion or enlarge grip to resist needle retraction. The reduction of grip can be achieved passively through form modification and actively through translation and rotation of the needle. To enlarge grip, interlocking with the tissue, sucking the tissue, and adhering to the tissue were identified as strategies. Needle propelling was modified to ensure stable needle insertion, either through external (i.e. applied to the prepuncturing movement of the needle) or internal (i.e. applied to the postpuncturing movement of the needle) strategies. External strategies include free-hand and guided needle insertion, while friction manipulation of the tissue was found to be an internal strategy. Most needles appear to be using friction reduction strategies and are inserted using a free-hand technique. Furthermore, most needle designs were inspired by insects, specifically parasitoid wasps, honeybees, and mosquitoes. The presented overview and description of the different bioinspired interaction and propulsion strategies provide insight into the current state of bioinspired needles and offer opportunities for medical instrument designers to create a new generation of bioinspired needles.

Insects are important agents in ecosystems. Their diverseness and developed coping mechanisms also make them interesting for direct application and as a source of inspiration in medical engineering. We summarized the main contribution of insects in biomedical applications. Medical centers in North America, and Europe use fly larvae for maggot therapy to remove necrotic tissue, decrease infection risk, and improve wound healing. Ant mandibles are used as a suturing technique by African tribes and as sources of inspiration for surgical clamps. Both the mosquito fascicle and the wasp ovipositor are sources of inspiration for the design of medical needles. Herein, a new research field called 'entomomedical engineering,' is proposed. We define entomomedical engineering as the branch of engineering that uses insects either directly or as a source of inspiration to design and develop medical treatments or instruments. In addition, we want to emphasize the importance of preserving insects because of their function in the ecosystem, medicine, and medical engineering.

Introduction: Conventional cancer treatments such as radical surgery and systemic therapy targeting the organ or organ system might have side effects because of damage to the surrounding tissue. For this reason, there is a need for new instruments that focally treat cancer. Areas covered: This review provides a comprehensive overview of the patent literature on minimally and noninvasive focal therapy instruments to treat localized cancer. The medical section of the Google Patents database was scanned, and 128 patents on focal therapy instruments published in the last two decades (2000–2021) were retrieved and classified. The classification is based on the treatment target (cancer cell or network of cancer cells), treatment purpose (destroy the cancerous structure or disable its function), and treatment means (energy, matter, or a combination of both). Expert opinion: We found patents describing instruments for all groups, except for the instruments that destroy a cancer cell network structure by applying matter (e.g. particles) to the network. The description of the different treatment types may serve as a source of inspiration for new focal therapy instruments to treat localized cancer.

Motor performance deficits are major issues impacting functional activities in older adults. Herein, we used locusts, emergent model organisms for neurodegeneration and motor deficit studies, to investigate the role of cognition as compensation strategy to age-related motor activation deficiency. An animal-robot interaction has been established to evoke anti-predator motor responses in locusts. We found a significantly earlier decision making of older adults that displayed their first motor response at a significantly longer distance from the approaching robotic predator, compared to young adults. Although older adult locusts reacted earlier to the approaching robot, performing a wider movement with their hind leg if compared to young adults, older adults obtained a body displacement significantly shorter than the body displacement of younger individuals. The earlier reaction in older adult locusts is probably due to a strategic behavior compensating a slower muscular response that may require a longer time to be performed, and this is consistent with other compensation strategies reported in humans. To the best of our knowledge this research represents a pilot study using ethorobotics to characterize associations between cognitive and motor functions, adding basic information on high-speed sensory-motor activation, that can be exploited to ameliorate motor decline in older adults.