Grid electrodes for robotic prostate surgery

Abstract

A net grid electrode assembly, system, and method includes a net grid electrode substrate having an arrangement of openings forming a mesh configuration that can be draped over the prostate or other pelvic structure, a plurality of electrodes embedded in the net grid electrode substrate and placed in a regular or irregular pattern at intersection of the mesh, and a plurality of wire leads, each wire lead having a first portion embedded in the electrode base and a second portion extending from the electrode base, wherein each electrode is associated with a distinct one of the plurality of wire leads.

Description

125757-10702-772270612 / 31 / 20251GRID ELECTRODES FOR ROBOTIC PROSTATE SURGERYCROSS-REFERENCE TO RELATED APPLICATION(S) This PCT application claims priority from United States Provisional Patent Application No 63 / 840,990 entitled NET GRID ELECTRODE FOR ROBOTIC PROSTATE SURGERY filed July 9, 2025 (Docket No. 125757-10704), United States Provisional Patent Application No. 63 / 757,611 entitled NET GRID ELECTRODE FOR ROBOTIC PROSTATE SURGERY filed February 12, 2025 (Docket No. 125757-10703), and United States Provisional Patent Application No.63 / 741,513 entitled NET GRID ELECTRODE FOR ROBOTIC PROSTATE SURGERY filed January 3, 2025 (Docket No. 125757-10701), each of which is hereby incorporated herein by reference in its entirety.This PCT application also claims priority from United States Provisional Patent Application No. 63 / 741,511 entitled VIRTUAL ELECTRODE ARRAY AND PROSTATE SURGICAL PROCEDURE USING SAME filed January 3, 2025 (Docket No. 125757-10601), which is hereby incorporated herein by reference in its entirety.This PCT application also claims priority from United States Provisional Patent Application No. 63 / 741,515 entitled CURVED GRID ELECTRODE FOR ROBOTIC PROSTATE SURGERY filed January 3, 2025 (Docket No. 125757-10801), which is hereby incorporated herein by reference in its entirety.The subject matter of this patent application may be related to the subject matter of PCT Patent Application No. PCT / US2025 / 047641 entitled VEIL PROSTATE ELECTRODE ASSEMBLY filed September 24, 2025 (Docket No.125757-10402), which claims the benefit of United States Provisional Patent Application No. 63 / 757,607 entitled VEIL PROSTATE ELECTRODE filed February 12, 2025, United States Provisional Patent Application No. 63 / 724,601 entitled VEIL PROSTATE ELECTRODE filed November 25, 2024, and United States Provisional Patent Application No. 63 / 698,124 entitled VEIL PROSTATE ELECTRODE filed September 24, 2024, each of which is hereby incorporated herein by reference in its entirety.125757-10702-772270612 / 31 / 20252FIELD OF THE INVENTIONThe invention generally relates to electrodes for use in robotic prostate surgery.BACKGROUND OF THE INVENTIONDuring prostate surgery (e.g., due to prostate cancer), the surgeon needs to remove the prostate but avoid the nerves that are needed for urinary continence and erectile function. These nerves are very close to the prostate and can be damaged during prostate removal. In traditional prostate removal surgery, the surgeon approaches the prostate through the belly. The prostate is under the pelvic floor, so the surgeon exposes the prostate, removes the urethra, and then removes the prostate. One issue is that nerves that control urination and erectile function run alongside the prostate, under the pelvic floor, and can be damaged during the surgery. Unal, et al., Cavernous nerve mapping methods for radical prostatectomy, provides a good background of the nerve damage issues and an overview of a number of nerve mapping methods.SUMMARY OF VARIOUS EMBODIMENTSOne embodiment includes a net grid electrode is formed of netting with electrodes placed at intersections of netting strands.Another embodiment includes a net grid electrode comprises a net grid electrode substrate having an arrangement of openings formed by strips of substrate materials with electrodes placed at intersections of strips.Another embodiment includes a net grid electrode comprises a net grid electrode substrate having an arrangement of openings formed by strips of substrate materials with electrodes placed in vertical columns.Another embodiment includes a net grid electrode comprises a net grid electrode substrate having an arrangement of openings formed by strips of substrate materials with electrodes placed in horizontal rows.Another embodiment includes a curved grid electrode.Another embodiment includes a perforated grid electrode.125757-10702-772270612 / 31 / 20253Another embodiment includes producing a map of predicted nerve locations from nerve monitoring of a plurality of patients.Another embodiment includes producing a display on a display device including a map of predicted nerve locations projected or overlayed onto an image of the prostate and pelvic floor (e.g., MRI, ultrasound, photographic, or other image), optionally including monitoring nerve function (e.g., using a rectal plug electrode) and updating the display to indicate nerve activity (e.g., changing a representation of a nerve from green to red if the nerve is irritated).Additional embodiments may be disclosed and claimed.BRIEF DESCRIPTION OF THE DRAWINGSThose skilled in the art should more fully appreciate advantages of various embodiments of the invention from the following “Description of Illustrative Embodiments,” discussed with reference to the drawings summarized immediately below.FIG. 1 shows a prior art grid electrode overlayed on a prostate during a prostate surgical procedure.FIG. 2 shows a fishing net representing a model on which certain embodiments of the invention were modeled.FIGs. 3-5 show a first exemplary embodiment of a net grid electrode, where FIG. 3 shows the net grid electrode substrate, FIG. 4 shows the size of the net grid electrode substrate relative to a dime, and FIG. 5 shows possible placements of electrodes in or on the net grid electrode substrate (where the electrodes are represented by the dots at the intersections of the substrate material).FIGs. 6-8 show a second exemplary embodiment of a net grid electrode substrate having a higher density of intersections / electrodes than the first embodiment, where FIG. 6 shows the net grid electrode substrate, FIG. 7 shows the size of the net grid electrode substrate relative to a dime, and FIG. 8 shows possible placements of some of the electrodes in or on the net grid electrode substrate (where the electrodes are represented by the dots at the intersections of the substrate material).125757-10702-772270612 / 31 / 20254FIG. 9 is a schematic diagram showing representations of alternative arrangements of openings for a net grid electrode substrate.FIG. 10 is a schematic diagram showing another alternative embodiment of a net grid electrode (referred to herein as a “butterfly” or “BF” grid).FIG. 11 is a schematic diagram showing the concept of the BF grid of FIG. 10 with stiffeners or shaping flexures in accordance with certain embodiments.FIGs. 12-14 are schematic diagrams showing approximate dimensions and some possible electrode configurations for a small cruciform or stellate net grid electrode in accordance with certain embodiments.FIGs. 15-17 are schematic diagrams showing approximate dimensions and some possible electrode configurations for a large cruciform or stellate net grid electrode in accordance with certain embodiments.FIGs. 18-20 are schematic diagrams showing some possible horizontal electrode configurations in accordance with certain embodiments.FIG. 21 is a schematic diagram showing one example of a curved grid electrode in accordance with certain embodiments.FIG. 22 is a schematic diagram showing examples of perforated grid electrodes, in accordance with certain embodiments.FIG. 23 is a schematic diagram showing a representation of nerves projected or overlayed onto an MRI image, in accordance with certain embodiments.It should be noted that the foregoing figures and the elements depicted therein are not necessarily drawn to consistent scale or to any scale. Unless the context otherwise suggests, like elements are indicated by like numerals. The drawings are primarily for illustrative purposes and are not intended to limit the scope of the inventive subject matter described herein.DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS Generally speaking, the purpose of electrodes used during prostate surgery is to help determine the location of nerves under the pelvic floor that are responsible for bladder control and erections. If the surgeon knows where the nerves are, then the surgeon can try to avoid the nerves when exposing and removing the prostate, thereby reducing the chances of causing bladder control or erectile function issues.125757-10702-772270612 / 31 / 20255Some prostate surgical procedures currently use physical grid electrodes (e.g., overlayed directly or indirectly over the prostate), but these electrodes tend to get in the way of the surgeon. FIG. 1 shows a prior art grid electrode overlayed on a prostate during a prostate surgical procedure. As can be imagined, the configuration of this grid electrode could get in the way of the surgeon and could make robotic surgery difficult. Also, even though this grid electrode includes a flexible substrate, this grid electrode is not sufficiently flexible to always conform to the prostate (or, if used in other pelvic surgeries, to other pelvic structures), as can be seen in FIG. 1.Certain embodiments disclosed herein relate to grid electrodes designed for monitoring and recording bioelectrical signals on the surface of the prostate and pelvic floor during surgical procedures. These electrodes are generally intended to enable functional mapping and localization for enhanced monitoring and surgical precision in prostate and pelvic floor surgeries. These electrodes generally are pliable such as for conformability to the prostate and pelvic floor, adjustability to anatomical variations, or insertion or removal via an access device such as a robotic surgery access device. The substrate material of the grid electrode generally enhances adhesion to the prostate and pelvic floor to ensure sustained electrode contact.NET GRID ELECTRODESTherefore, certain embodiments include a net grid electrode having a mesh configuration that can be draped over the prostate or other pelvic structure. This net grid electrode was modeled by the inventors on a fishing net of the type shown in FIG. 2, e.g., where electrodes could be placed in a regular or irregular pattern at the intersection of multiple strands (e.g., where the knots are formed) and where electrical leads for the electrodes could be embedded in or otherwise supported by the strands. Thus, for example, a net grid electrode could be formed using a net such as shown in FIG. 2 with electrodes placed at locations where the netting intersects. Since the net grid electrode needs to be very flexible, an embodiment might use single strands of thin flexible netting material (which may be formed at least in part from thin wire electrode leads) rather than double strands of netting material as in FIG. 2.Conceptually, the configuration of the net structure (e.g., the number and125757-10702-772270612 / 31 / 20256configuration of openings, the sizes and shapes of the openings, the thickness and configuration of the material between the openings / electrodes, etc.) and the use of thin flexible netting material help to allow the net grid electrode to be sufficiently flexible to conform to the prostate or other pelvic structure.However, rather than literally using a fishing net arrangement, the inventors envision using a two-dimensional grid formed of very flexible material with the electrodes placed at intersections of the mesh and electrical leads running along or through the material between the openings / electrodes.FIGs. 3-5 show a first exemplary embodiment of a net grid electrode, where FIG. 3 shows the net grid electrode substrate, FIG. 4 shows the size of the net grid electrode substrate relative to a dime, and FIG. 5 shows possible placements of electrodes in or on the net grid electrode substrate (where the electrodes are represented by the dots at the intersections of the substrate material).FIGs. 6-8 show a second exemplary embodiment of a net grid electrode substrate having a higher density of intersections / electrodes than the first embodiment, where FIG. 6 shows the net grid electrode substrate, FIG. 7 shows the size of the net grid electrode substrate relative to a dime, and FIG. 8 shows possible placements of some of the electrodes in or on the net grid electrode substrate (where the electrodes are represented by the dots at the intersections of the substrate material). In this embodiment, the openings are approximately 1 mm per side and the shape is a square or diamond shape.FIG. 10 is a schematic diagram showing another alternative embodiment of a net grid electrode (referred to herein as a “butterfly” or “BF” grid). The BF grid essentially includes a central “fish net” matrix of the types described herein surrounded by four side lobes, a top lobe, and a bottom lobe, with stress-relief zones in between the lobes to result in a “butterfly” configuration that can conform to the top and sides of the prostate. In this example, the BF grid includes holes along the lobe edges that can be used to suture the BF grid in place. The BF grid includes electrodes, which in this example are positioned along the sides of the side lobes (e.g., two rows of four electrodes on each lobe) although alternative embodiments can include different electrode configurations (e.g., single row of electrodes on each side lobe, zig-zag pattern of electrodes on each side lobe, electrodes on the top lobe,125757-10702-772270612 / 31 / 20257electrodes on the bottom lobe, etc.) as well as in the central “fish net” matrix as described herein. In this example, electrode leads (not shown) would extend from the electrodes via the bottom lobe and end in a 4-5 ft ribbon cable that goes to a connection, although other configurations are possible (e.g., electrode leads extending from the electrodes via the top lobe). In this example, the BF grid is approximately 3.5 inches long and 2.5 inches wide and is made of a soft silicone-type material that is 0.4 mm thick, although other dimensions and materials may be used in various alternative embodiments. Stiffeners or shaping flexures (e.g., one or more metal liners allowing the user to bend the BF grid into a desired shape that is retained by the shaping flexures) may be embedded in or attached onto the BF grid material, as depicted schematically in FIG. 11. For example, the BF grid substrate may be formed from two layers with components such as stiffeners, shaping flexures (a “star-shaped” piece of malleable metal), electrodes, and / or electrode leads sandwiched between the two layers, or the grid substrate could be molded around such components. The contacts may be 2 mm diameter electrodes and may be spaced approximately 7 mm center-to-center, although other configurations are possible.FIGs. 12-17 are schematic diagrams showing additional alternative embodiments of “butterfly” type net grid electrodes characterized having a cruciform (X-shaped) or stellate (star-shaped) substrate. FIGs. 12-14 show approximate dimensions and some possible electrode configurations for a small cruciform or stellate net grid electrode. FIGs. 15-17 show approximate dimensions and some possible electrode configurations for a large cruciform or stellate net grid electrode. It should be noted that a medium cruciform or stellate net grid electrode may have dimensions of around 2 inches long by 2 inches wide by 3 inches diagonal.In certain embodiments (e.g., the embodiment shown in FIG. 10, the highlighted electrodes are arranged substantially in vertical columns (e.g., running “north-to-south”). Based on normal anatomical orientation, the nerves of interest run north-to- south but also have a wide distribution east-to-west. Because of normal variability, the distribution is not consistent across individuals.Therefore, certain embodiments may have electrodes that are arranged to form two horizontal rows that are approximately 1 inch apart (although the specific interrow distance can vary based upon the overall dimensions of the grid or other125757-10702-772270612 / 31 / 20258considerations such as the size or anatomy of a particular patient). The rows may consist of electrodes that are evenly spaced across the grid’s substrate material. The interelectrode distance can vary, e.g., based on the number of electrodes placed and the physical width of the grid. In certain embodiments, it is contemplated that net grid electrodes with horizontally arranged electrodes will come in small, medium and large sizes (e.g., similar in size and substrate configuration described above with reference to FIGs. 12-17). In certain embodiments, the small grid will include two rows of 5 contacts / electrodes per row as depicted schematically in FIG. 18, the medium grid will include two rows of 7 contacts each as depicted schematically in FIG. 19, and the large grid will include two rows of 9 contacts each as depicted schematically in FIG. 20, with contacts / electrodes preferably evenly spaced with the center-to-center distance determined by the width of the grid. Of course, additional or alternative net grid electrodes having different substrate configurations and electrode configurations are possible.Similar to the net embodiments discussed above, conceptually, the configuration and material of the net grid electrode substrate structure (e.g., the number and configuration of openings, the sizes and shapes of the openings, the thickness and configuration of the material between the openings / electrodes, etc.) help to allow the net grid electrode to be sufficiently flexible to conform to the prostate or other pelvic structure. Although the openings in the embodiments shown in FIGs. 3-8 can be characterized as being in linear arrangements (i.e., along the diagonals in the figures), it should be noted that the openings can be arranged in other ways such as to assist with conformance to curved structures such as the prostate (e.g., some openings could have varying sizes and shapes along a curve as depicted schematically in FIG.9).In certain embodiments, the net grid electrode substrate may be formed of silicone that is 0.4 mm thick, although alternative embodiments can use other flexible materials and / or other thicknesses (and thickness may vary across the net grid electrode substrate, e.g., thicker in the middle and thinner at the edges for added flexibility / conformability.125757-10702-772270612 / 31 / 20259In certain embodiments, the electrodes may be 2 mm electrodes and may be spaced around 2-4 mm apart, although various alternative embodiments may use other sizes and / or spacing.It also should be noted that electrodes do not need to be placed at every intersection of the net or net grid electrode substrate.It also should be noted that electrodes can be placed elsewhere in or on the net or net grid electrode substrate, e.g., at the corners and / or along the edges and / or along the strands.In certain embodiments, the net or net grid electrode substrate may be around 50 mm by 50 mm, although net grid electrodes can be other sizes and need not be rectangular but instead could be any appropriate shape (e.g., the corners of the rectangular structure could be cropped to form an octagon structure, or the substrate could be round or oval, etc.).It is envisioned that net grid electrodes will be fabricated in multiple shapes and / or sizes so that the surgeon can select an appropriate net grid electrode based on, for example, the size of the prostate, the area of the pelvic floor, how much exposure is needed, etc.The net grid electrode generally will have one or more (e.g., two) cables for connecting the electrodes of the net gride electrode to a computer (e.g., via a “touch proof’ connector at the end of each cable). It is envisioned that the length of the cable(s) will be approximately 4 ft, although of course other lengths are possible.It is contemplated that net grid electrodes will be particularly useful in urologic surgeries such as prostate surgeries and gynecological surgeries. In certain surgical procedures, the net grid electrode would be placed and optionally secured over the prostate or other pelvic structure and used to map and / or monitor the nerves. A map of the nerves may be overlayed on images of the prostate or pelvic structure displayed on a display device on a static or dynamic basis, e.g., overlayed on an MRI or photographic image, as discussed in a related patent application. When used for mapping nerves as part of a prostate or other procedure, the net grid electrode may be removed for the actual surgical procedure. A second electrode array (e.g., a curved grid electrode as discussed in a related patent application) may be used to monitor the nerves during the surgery.125757-10702-772270612 / 31 / 202510CURVED GRID ELECTRODESCertain embodiments include a curved grid electrode that is generally described by the inventors as having a “C” shape, although others might refer to it as a “U” shape or crescent shape or other appropriate description. FIG. 21 shows one example of a curved grid electrode in accordance with certain embodiments. This curved grid electrode has a top portion and two “pant leg” portions extending downward from the top portion and leaving a space between the two pant leg portions. The top portion and the two pant leg portions are generally formed of a single or unitary substrate although in alternative embodiments the top portion and the pant leg portions may be formed of separate substrate (e.g., glued or otherwise attached together). The substrate(s) is / are formed a highly flexible material so that the curved grid electrode can drape across the top of the prostate and lay naturally on the sides of the prostate. In certain embodiments, the substrate(s) may be formed of silicone that is 0.4 mm thick, although alternative embodiments can use other flexible materials and / or other thicknesses (and thickness may vary across the net grid electrode substrate, e.g., thicker in the middle and thinner at the edges for added flexibility / conformability.Overall, this example curved grid electrode is approximately 6 cm long by approximately 12 cm wide (e.g., where the segment across the top portion would be about 25 mm long and each pant leg beyond the 25 mm long section top portion would be about 25 mm long), although curved grid electrodes may be fabricated in multiple shapes and / or sizes so that the surgeon can select an appropriate net grid electrode based on, for example, the size of the prostate, the area of the pelvic floor, how much exposure is needed, etc.In certain embodiments, the substrate(s) will include one or more support elements, e.g., fine malleable wire in or on the substrate material about the outer edge of the pant legs and across the top edge (where a belt would be if these were pants) will help the grid conform to the shape of the prostate.The top portion and pant leg portions include electrodes (e.g., 1 mm or 2 mm diameter electrodes with around 2-4 mm spacing inter-electrode distance) with the electrodes embedded in or otherwise supported by the base material (e.g., on the125757-10702-772270612 / 31 / 202511surface of the base material). The size and / or spacing of the electrodes could depend on the amount of flexibility of the base material, e.g., fewer electrodes may be needed for a very flexible base material. The size and / or spacing of the electrodes also could depend on the shape and / or size of the curved grid electrode as discussed above. Electrical leads for the electrodes also could be embedded in the base material or otherwise supported by the base material (e.g., wires on a surface of the base material). This embodiment includes holes on the top portion and pant leg portions to allow for suturing of the curved grid array, e.g., onto the prostate or onto tissue about the prostate. In this embodiment, electrical leads for the electrodes extend from the two pant leg portions, i.e., at the “cuff’ end of the pant leg portions.The curved grid electrode generally will have one or more (e.g., two) cables for connecting the electrodes of the curve gride electrode to a computer (e.g., via a “touch proof’ connector at the end of each cable). It is envisioned that the length of the cable(s) will be approximately 4 ft, although of course other lengths are possible.It is contemplated that urologic surgery, and in particular prostate surgery, will utilize the curved grid electrode to monitor nerves during surgery while providing space between the two pant leg portions for the surgeon or surgical robot to operate. In certain surgical procedures, a first electrode array (e.g., a fish net type electrode array described in a related patent application) may be used to map the nerves, this first electrode array would then be removed, then the curved grid electrode would be placed and secured (e.g., suturing).PERFORATED GRID ELECTRODESCertain embodiments include a grid electrode that is perforated into substantially rectangular sections that can be partially or fully separated such as to allow for variable flexibility or conformity (e.g., to accommodate differences in patient habitus, prostate size, etc.) or to allow for separation of the grid electrode into two or more parts while maintaining individual electrode functionality (e.g., without cutting or damaging the electrodes / wiring) such as to enable adjustable widths or to enable dual function uses as discussed further below.125757-10702-772270612 / 31 / 202512FIG. 22 is a schematic diagram showing four proposed perforated grid designs including specifics as to dimensions, suture sites, placement of the electrodes, and other details, in accordance with various embodiments. In these example perforated grid designs, each perforation-separated strip is around 62 mm long and around either 8 mm or 10 mm wide. The perforated grid electrode (A) includes five 10 mm wide strips, the perforated grid electrode (B) includes four 10 mm wide strips, the perforated grid electrode (C) includes five 8 mm side strips, and the perforated grid electrode (D) includes four 8 mm wide strips. All four of the represented embodiments include suture alignment indicators integrated into the substrate (i.e., the black dots along the top and bottom edges) to indicate suggested suture locations (e.g., in these examples, three suture sites on each strip with one dot centered at the top of each strip and two more at the base straddling the wiring). The suture alignment indicators can be perforated to facilitate suturing if necessary or desired. The distance between the electrode at the base of the material and the connection to the lead is approximately 6-8 mm. The substrate is pliable (e.g., silicone, polyurethane, etc., preferably less than or equal to around 4 mm thick). Of course, other embodiments can have different numbers, widths, lengths, numbers of electrodes, electrode placements, and suture locations (including along strip edges) than the represented embodiments. In these examples, the electrodes are 2 mm in diameter and are made of stainless steel, although other sizes and materials may be used in various alternative embodiments. In these examples, the lead cable is at least around 60 cm in length and terminates in Touchproof pins. These examples include a sliding sleeve over the wires that will gather the electrode wires / leads and optionally include a suture hole that can be used to suture the sliding sleeve (and therefore the electrode wires / leads) in place. Such embodiments may include an intermediate cable that connects the grid lead and the data collection platform, which may be around 120 cm long and generally must be sterilizable and reusable.It should be noted that perforated grid electrodes of the types shown in the figure can be customized to various sizes, e.g., removing or separating one or more strips of a multiple-strip electrode to customize the width of the electrode.It should be noted that the perforations may be used to partially separate one or more strips, e.g., leaving the strips in place but opening a space between two or125757-10702-772270612 / 31 / 202513more adjacent strips such as to add flexibility or conformance to a curved surface such as a prostate.It should be noted that perforated grid electrodes of the types shown in the figure can be separated into two or more parts such as for dual function uses as discussed below, e.g., using a full 4-strip electrode for initial localization and then separating the 4-strip electrode into two 2-strip parts for placement on opposite sides of the prostate during the surgical procedure.VIRTUAL GRID ELECTRODECertain embodiments use a virtual electrode array that is essentially a virtual representation of the nerves overlayed on an MRI or other image of the patient’s prostate. In this way, nerve localization information can be provided to the surgeon without having a physical electrode in place (in some cases, a physical electrode can obstruct or impede the surgeon). The virtual grid array also can be used to help guide surgical robots. Furthermore, there is a new surgical approach that is being developed where, instead of going straight through the belly and removing the prostate, the surgery is done from under the prostate to remove it while trying to avoid the nerves cited above. One problem here is that the pelvic floor is not exposed, so an electrode cannot be placed on the prostate to identify the location of nerves.Therefore, in certain embodiments, a map of predicted nerve locations (sometimes referred to herein as a virtual grid array or electrode) is formed by mapping the location of nerves across a number of patients (e.g., an initial sampling of 350 or so patients) such as by placing a grid electrode on the pelvic floor of the patients and recording data to identify the location of nerves, and using this data to produce a map of predicted nerve locations that can be used for future patients.The map of predicted nerve locations can be enhanced and / or updated over time, e.g., using nerve mapping data from additional patients, using artificial intelligence / machine learning (AI / ML) systems (e.g., based on human-annotated prostate and nerve images), using feedback from surgical procedures, etc. The map of predicted nerve locations can be used generically (e.g., the same map applied to multiple future patients) or customized nerve maps can be produced for individual125757-10702-772270612 / 31 / 202514patients (e.g., using AI / ML systems to produce a customized nerve map for a given patient based on the generic nerve map information and patent-specific information such as age, race, etc.).In certain embodiments, the map of predicted nerve locations and an MRI, ultrasound, photographic, or other image of the prostate and pelvic floor are provided to a computer system configured to produce a display (e.g., on a robotic surgical system monitor) including the map of predicted nerve locations projected or overlay ed onto the MRI, ultrasound, photographic, or other image of a patient’s prostate and pelvic floor, which may involve the computer system performing any of various image processing techniques on the map of predicted nerve locations and / or the image (e.g., scaling, skewing, de-skewing, converting 3D information to 2D graphics, etc.) to match the map of predicted nerve locations to the image of the patient’s prostate and other pelvic structures. FIG. 23 is a schematic diagram showing a representation of nerves projected or overlayed onto an MRI image, in accordance with certain embodiments. The inventors are aware of procedures in which an MRI image of the prostate is overlayed by an ultrasound image of the prostate so that the surgeon sees these two overlayed images and uses that to guide a biopsy needle to locations that contain a tumor (e.g., Koelis and Euronav systems), but the inventors are unaware of any mapping of predicted nerve locations over an MRI or other image of the prostate. During surgery, the inventors would plan to do some other monitoring, simultaneously, to ensure that the real nerves are not being irritated (e.g., using a rectal plug electrode to monitor nerve activity).The following is high-level description of the process for producing and using the map in accordance with certain embodiments:1. Collect data using an actual grid array during prostate surgery, e.g., collect data multiple times from 350 patients undergoing prostate surgery.2. Based upon these data, determine the distribution of the neural plexus across subjects (of course, there will be some variance in nerve locations across patients, but the inventors believe that the locations of the nerves should be relatively consistent across patients).125757-10702-772270612 / 31 / 2025153. Using statistical methods, develop a map of the nerve plexus that depicts the mean location of nerves and their variance across subjects.4. In addition to the grid array, use a plug electrode inserted into the rectum to stimulate and record nerve activity - this data will provide information about the midline below the prostate and will be used as a point of reference when placing the virtual grid electrode.5. During surgery, display the data from the virtual grid electrode and overlay it on an image of the prostate (e.g., an MRI image, an ultrasound image, an actual photo of the prostate area, or some other image) using the data from the plug electrode to help center the virtual grid electrode over the prostate image.6. During the removal of the prostate, the virtual grid electrode will be in place so that the surgeon can “see” the predicted nerve distribution.7. If a nerve is irritated during prostate exposure, removal, etc., e.g., as detected using the rectal plug electrode, the computer system will generate an alert, e.g., the display of the nerve being irritated can be changed from green to red and shown on the overlay, an audible alert can be generated, etc. For robotic surgery, the robot controller could automatically stop the surgical procedure upon such detection, e.g., until a human can intervene to decide whether or how to proceed.MISCELLANEOUSIt should be noted that grid electrodes such as net grid electrodes, curved grid electrodes, perforated grid electrodes, and veil / butterfly grid electrodes of the types described herein may be configured and fabricated to allow the grid electrode to be compressed (e.g., rolled or folded) for delivery and / or retrieval through the port of an access device such as through the 30.5 mm port of a surgical robot access device. Thus, for example, the substrate of the grid electrode is generally pliable such as for conformity with the prostate and pelvic floor and to allow for rolling or folding to fit within the access device.It should be noted that net grid electrodes, curved grid electrodes, and veil / butterfly grid electrodes of the types described herein may include perforations, similar to the perforations included in the perforated grid electrodes, such as to allow125757-10702-772270612 / 31 / 202516for variable flexibility or conformity or to allow for separation of the grid electrode into two or more parts (e.g., separating a curved or veil / butterfly electrode into two substantially-equal halves, or separating a net grid electrode into two or more strips).In any case, the ability to separate a grid electrode into two or more separate parts while maintaining electrodes and leads within the multiple parts (whether using perforations, cutting along openings in a net grid electrode, or otherwise) allows for dual function uses, e.g., a single grid electrode that supports both localization and monitoring, where localization can be performed initially to identify the location of nerves and then the grid electrode can be separated into multiple parts and used to monitor nerve function during exposure and removal of the prostate or other surgical procedure.It should be noted that any of the described substrate materials, substrate thicknesses, electrode sizes, electrode materials, electrode leads, and other such details may be applied to any of the net, curved, perforated, or veil / butterfly electrodes. For example, any embodiment may include a sliding sleeve over the wires that will gather the electrode wires / leads and optionally include a suture hole that can be used to suture the sliding sleeve (and therefore the electrode wires / leads) in place. Such embodiments may include an intermediate cable that connects the grid lead and the data collection platform, which may be around 120 cm long and generally must be sterilizable and reusable.It should be noted that, while various embodiments are discussed herein with reference to prostate surgeries, grid electrodes and the virtual grid array concept may be used in other types of pelvic and possible other surgeries.While various inventive embodiments have been described and illustrated herein, those of ordinary skill in the art will readily envision a variety of other means and / or structures for performing the function and / or obtaining the results and / or one or more of the advantages described herein, and each of such variations and / or modifications is deemed to be within the scope of the inventive embodiments described herein. More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are meant to be exemplary and that the actual parameters, dimensions, materials, and / or configurations will depend upon the specific application or applications for which the125757-10702-772270612 / 31 / 202517inventive teachings is / are used. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific inventive embodiments described herein. It is, therefore, to be understood that the foregoing embodiments are presented by way of example only and that, within the scope of the appended claims and equivalents thereto, inventive embodiments may be practiced otherwise than as specifically described and claimed. Inventive embodiments of the present disclosure are directed to each individual feature, system, article, material, kit, and / or method described herein. In addition, any combination of two or more such features, systems, articles, materials, kits, and / or methods, if such features, systems, articles, materials, kits, and / or methods are not mutually inconsistent, is included within the inventive scope of the present disclosure.It should be noted that headings are used above for convenience and are not to be construed as limiting the present invention in any way.It should be noted that the figures and all text and concepts contained in the figures are considered to be included in this detailed description as part of the specification and disclosure of this patent application.It should be noted that some or all features of certain embodiments may be aspirational (e.g., contemplated or intended for future or optional implementation) notwithstanding any description using past tense or present tense wording (e.g., a feature was or is or does or provides something, which does not necessarily mean that the feature has already been implemented or ever will be implemented). Similarly, some or all performance information (e.g., that a particular embodiment will produce or provide a particular performance level or outcome) may be aspirational or anticipated as opposed to being already tested or proven.Various embodiments of the invention may be implemented at least in part in any conventional computer programming language. For example, some embodiments may be implemented in a procedural programming language (e.g., “C”), or in an object-oriented programming language (e.g., “C++”). Other embodiments of the invention may be implemented as a pre-configured, stand-alone hardware element and / or as preprogrammed hardware elements (e.g., application specific integrated circuits, FPGAs, and digital signal processors), or other related components.125757-10702-772270612 / 31 / 202518In alternative embodiments, the disclosed apparatus and methods (e.g., as in any flow charts or logic flows described above) may be implemented as a computer program product for use with a computer system. Such implementation may include a series of computer instructions fixed on a tangible, non-transitory medium, such as a computer readable medium (e.g., a diskette, CD-ROM, ROM, or fixed disk). The series of computer instructions can embody all or part of the functionality previously described herein with respect to the system.Those skilled in the art should appreciate that such computer instructions can be written in a number of programming languages for use with many computer architectures or operating systems. Furthermore, such instructions may be stored in any memory device, such as a tangible, non-transitory semiconductor, magnetic, optical or other memory device, and may be transmitted using any communications technology, such as optical, infrared, RF / microwave, or other transmission technologies over any appropriate medium, e.g., wired (e.g., wire, coaxial cable, fiber optic cable, etc.) or wireless (e.g., through air or space).Among other ways, such a computer program product may be distributed as a removable medium with accompanying printed or electronic documentation (e.g., shrink wrapped software), preloaded with a computer system (e.g., on system ROM or fixed disk), or distributed from a server or electronic bulletin board over the network (e.g., the Internet or World Wide Web). In fact, some embodiments may be implemented in a software-as-a-service model (“SAAS”) or cloud computing model. Of course, some embodiments of the invention may be implemented as a combination of both software (e.g., a computer program product) and hardware. Still other embodiments of the invention are implemented as entirely hardware, or entirely software.Computer program logic implementing all or part of the functionality previously described herein may be executed at different times on a single processor (e.g., concurrently) or may be executed at the same or different times on multiple processors and may run under a single operating system process / thread or under different operating system processes / threads. Thus, the term “computer process” refers generally to the execution of a set of computer program instructions regardless of whether different computer processes are executed on the same or different125757-10702-772270612 / 31 / 202519processors and regardless of whether different computer processes run under the same operating system process / thread or different operating system processes / threads. Software systems may be implemented using various architectures such as a monolithic architecture or a microservices architecture.It should be noted that terms such as “computer” or “controller” may be used herein to describe devices or systems that may be used in certain embodiments of the present invention and should not be construed to limit the present invention to any particular device or system type unless the context otherwise requires. Such devices or systems typically include one or more network interfaces for communicating over a communication network and at least one processor (e.g., a microprocessor with memory and other peripherals and / or application-specific hardware) configured accordingly to perform device or system functions. Communication networks generally may include public and / or private networks; may include local-area, wide-area, metropolitan-area, storage, and / or other types of networks; and may employ communication technologies including, but in no way limited to, analog technologies, digital technologies, optical technologies, wireless technologies (e.g., Bluetooth, WiFi, cellular, etc.), networking technologies, and internetworking technologies.It should also be noted that devices and systems may use communication protocols and messages (e.g., messages created, transmitted, received, stored, and / or processed by the device or system), and such messages may be conveyed by a communication network or medium. Unless the context otherwise requires, the present invention should not be construed as being limited to any particular communication message type, communication message format, or communication protocol. Thus, a communication message generally may include, without limitation, a frame, packet, datagram, user datagram, cell, or other type of communication message. Unless the context requires otherwise, references to specific communication protocols are exemplary, and it should be understood that alternative embodiments may, as appropriate, employ variations of such communication protocols (e.g., modifications or extensions of the protocol that may be made from time-to-time) or other protocols either known or developed in the future.It should also be noted that logic flows may be described herein to demonstrate various aspects of the invention, and should not be construed to limit the125757-10702-772270612 / 31 / 202520present invention to any particular logic flow or logic implementation. The described logic may be partitioned into different logic blocks (e.g., programs, modules, functions, or subroutines) without changing the overall results or otherwise departing from the true scope of the invention. Often times, logic elements may be added, modified, omitted, performed in a different order, or implemented using different logic constructs (e.g., logic gates, looping primitives, conditional logic, and other logic constructs) without changing the overall results or otherwise departing from the true scope of the invention.The present invention may be embodied in many different forms, including, but in no way limited to, computer program logic for use with a processor (e.g., a microprocessor, microcontroller, digital signal processor, or general purpose computer), programmable logic for use with a programmable logic device (e.g., a Field Programmable Gate Array (FPGA) or other PLD), discrete components, integrated circuitry (e.g., an Application Specific Integrated Circuit (ASIC)), or any other means including any combination thereof. Computer program logic implementing some or all of the described functionality is typically implemented as a set of computer program instructions that is converted into a computer executable form, stored as such in a computer readable medium, and executed by one or more processors optionally under the control of an operating system. Hardware-based logic implementing some or all of the described functionality may be implemented using one or more appropriately configured FPGAs or other programmable logic devices.Computer program logic implementing all or part of the functionality previously described herein may be embodied in various forms, including, but in no way limited to, a source code form, a computer executable form, and various intermediate forms (e.g., forms generated by an assembler, compiler, linker, or locator). Source code may include a series of computer program instructions implemented in any of various programming languages (e.g., an object code, an assembly language, or a high-level language such as Fortran, C, C++, JAVA, Python, or HTML) for use with various operating systems or operating environments. The source code may define and use various data structures and communication messages. The source code may be in a computer executable form (e.g., via an interpreter), or125757-10702-772270612 / 31 / 202521the source code may be converted (e.g., via a translator, assembler, or compiler) into a computer executable form.Computer program logic implementing all or part of the functionality previously described herein may be executed at different times on a single processor (e.g., concurrently) or may be executed at the same or different times on multiple processors and may run under a single operating system process / thread or under different operating system processes / threads. Thus, the term “computer process” refers generally to the execution of a set of computer program instructions regardless of whether different computer processes are executed on the same or different processors and regardless of whether different computer processes run under the same operating system process / thread or different operating system processes / threads.The computer program may be fixed in any form (e.g., source code form, computer executable form, or an intermediate form) either permanently or transitorily in a tangible storage medium, such as a semiconductor memory device (e.g., a RAM, ROM, PROM, EEPROM, or Flash-Programmable RAM), a magnetic memory device (e.g., a diskette or fixed disk), an optical memory device (e.g., a CD-ROM), a PC card (e.g., PCMCIA card), or other memory device. The computer program may be fixed in any form in a signal that is transmittable to a computer using any of various communication technologies, including, but in no way limited to, analog technologies, digital technologies, optical technologies, wireless technologies (e.g., Bluetooth), networking technologies, and internetworking technologies. The computer program may be distributed in any form as a removable storage medium with accompanying printed or electronic documentation (e.g., shrink wrapped software), preloaded with a computer system (e.g., on system ROM or fixed disk), or distributed from a server or electronic bulletin board over the communication system (e.g., the Internet or World Wide Web).

[0063] Hardware logic (including programmable logic for use with a programmable logic device) implementing all or part of the functionality previously described herein may be designed using traditional manual methods, or may be designed, captured, simulated, or documented electronically using various tools, such as Computer Aided Design (CAD), a hardware description language (e.g., VHDL or AHDL), or a PLD programming language (e.g., PALASM, ABEL, or CUPL).125757-10702-772270612 / 31 / 202522Programmable logic may be fixed either permanently or transitorily in a tangible storage medium, such as a semiconductor memory device (e.g., a RAM, ROM, PROM, EEPROM, or Flash-Programmable RAM), a magnetic memory device (e.g., a diskette or fixed disk), an optical memory device (e.g., a CD-ROM), or other memory device. The programmable logic may be fixed in a signal that is transmittable to a computer using any of various communication technologies, including, but in no way limited to, analog technologies, digital technologies, optical technologies, wireless technologies (e.g., Bluetooth), networking technologies, and internetworking technologies. The programmable logic may be distributed as a removable storage medium with accompanying printed or electronic documentation (e.g., shrink wrapped software), preloaded with a computer system (e.g., on system ROM or fixed disk), or distributed from a server or electronic bulletin board over the communication system (e.g., the Internet or World Wide Web). Of course, some embodiments of the invention may be implemented as a combination of both software (e.g., a computer program product) and hardware. Still other embodiments of the invention are implemented as entirely hardware, or entirely software.While the invention has been particularly shown and described with reference to specific embodiments, it will be understood by persons of ordinary skill in the art that various changes in form and detail may be made without departing from the spirit and scope of the invention as defined by the appended clauses. While some of these embodiments have been described in the claims by process steps, an apparatus comprising a computer capable of executing the process steps is also included in the present invention. Likewise, a computer program product comprising a tangible, non-transitory computer readable medium having embodied therein computer executable instructions for executing the process steps is included in the present invention. Data signals embodying computer program instructions and / or messages received or transmitted over a communication system are also included in the present invention. Unless the context requires otherwise, the various functions and features described herein can be used in combination even if disclosed or claimed individually. Thus, for example, it is contemplated that dependent claims included below could be rewritten into multiple dependent form to depend from the base claim and an intervening claim(s).125757-10702-772270612 / 31 / 202523Importantly, it should be noted that embodiments of the present invention may employ conventional components such as conventional computers (e.g., off-the-shelf PCs, mainframes, microprocessors), conventional programmable logic devices (e.g., off-the shelf FPGAs or PLDs), or conventional hardware components (e.g., off-the-shelf ASICs or discrete hardware components) which, when programmed or configured to perform the non-conventional methods described herein, produce non-conventional devices or systems. Thus, there is nothing conventional about the inventions described herein because even when embodiments are implemented using conventional components, the resulting devices and systems are necessarily non-conventional because, absent special programming or configuration, the conventional components do not inherently perform the described non-conventional functions.The activities described and claimed herein provide technological solutions to problems that arise squarely in the realm of technology. These solutions as a whole are not well-understood, routine, or conventional and in any case provide practical applications that transform and improve computers and computer routing systems.While various inventive embodiments have been described and illustrated herein, those of ordinary skill in the art will readily envision a variety of other means and / or structures for performing the function and / or obtaining the results and / or one or more of the advantages described herein, and each of such variations and / or modifications is deemed to be within the scope of the inventive embodiments described herein. More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are meant to be exemplary and that the actual parameters, dimensions, materials, and / or configurations will depend upon the specific application or applications for which the inventive teachings is / are used. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific inventive embodiments described herein. It is, therefore, to be understood that the foregoing embodiments are presented by way of example only and that, within the scope of the appended claims and equivalents thereto, inventive embodiments may be practiced otherwise than as specifically described and claimed. Inventive embodiments of the present disclosure are directed to each individual feature, system, article, material, kit, and / or method described herein. In addition, any125757-10702-772270612 / 31 / 202524combination of two or more such features, systems, articles, materials, kits, and / or methods, if such features, systems, articles, materials, kits, and / or methods are not mutually inconsistent, is included within the inventive scope of the present disclosure.Various inventive concepts may be embodied as one or more methods, of which examples have been provided. The acts performed as part of the method may be ordered in any suitable way. Accordingly, embodiments may be constructed in which acts are performed in an order different than illustrated, which may include performing some acts simultaneously, even though shown as sequential acts in illustrative embodiments.All definitions, as defined and used herein, should be understood to control over dictionary definitions, definitions in documents incorporated by reference, and / or ordinary meanings of the defined terms.The indefinite articles “a” and “an,” as used herein in the specification and in the claims, unless clearly indicated to the contrary, should be understood to mean “at least one.”The phrase “and / or,” as used herein in the specification and in the claims, should be understood to mean “either or both” of the elements so conjoined, i.e., elements that are conjunctively present in some cases and disjunctively present in other cases. Multiple elements listed with “and / or” should be construed in the same fashion, i.e., “one or more” of the elements so conjoined. Other elements may optionally be present other than the elements specifically identified by the “and / or” clause, whether related or unrelated to those elements specifically identified. Thus, as a non-limiting example, a reference to “A and / or B”, when used in conjunction with open-ended language such as “comprising” can refer, in one embodiment, to A only (optionally including elements other than B); in another embodiment, to B only (optionally including elements other than A); in yet another embodiment, to both A and B (optionally including other elements); etc.As used herein in the specification and in the claims, “or” should be understood to have the same meaning as “and / or” as defined above. For example, when separating items in a list, “or” or “and / or” shall be interpreted as being inclusive, i.e., the inclusion of at least one, but also including more than one, of a125757-10702-772270612 / 31 / 202525number or list of elements, and, optionally, additional unlisted items. Only terms clearly indicated to the contrary, such as “only one of’ or “exactly one of,” or, when used in the claims, “consisting of,” will refer to the inclusion of exactly one element of a number or list of elements. In general, the term “or” as used herein shall only be interpreted as indicating exclusive alternatives (i.e., “one or the other but not both”) when preceded by terms of exclusivity, such as “either,” “one of,” “only one of,” or “exactly one of.” “Consisting essentially of,” when used in the claims, shall have its ordinary meaning as used in the field of patent law.As used herein in the specification and in the claims, the phrase “at least one,” in reference to a list of one or more elements, should be understood to mean at least one element selected from any one or more of the elements in the list of elements, but not necessarily including at least one of each and every element specifically listed within the list of elements and not excluding any combinations of elements in the list of elements. This definition also allows that elements may optionally be present other than the elements specifically identified within the list of elements to which the phrase “at least one” refers, whether related or unrelated to those elements specifically identified. Thus, as a non-limiting example, “at least one of A and B” (or, equivalently, “at least one of A or B,” or, equivalently “at least one of A and / or B”) can refer, in one embodiment, to at least one, optionally including more than one, A, with no B present (and optionally including elements other than B); in another embodiment, to at least one, optionally including more than one, B, with no A present (and optionally including elements other than A); in yet another embodiment, to at least one, optionally including more than one, A, and at least one, optionally including more than one, B (and optionally including other elements); etc.As used herein in the specification and in the claims, all transitional phrases such as “comprising,” “including,” “carrying,” “having,” “containing,” “involving,” “holding,” “composed of,” and the like are to be understood to be open-ended, i.e., to mean including but not limited to. Only the transitional phrases “consisting of’ and “consisting essentially of’ shall be closed or semi-closed transitional phrases, respectively, as set forth in the United States Patent Office Manual of Patent Examining Procedures, Section 2111.03.125757-10702-772270612 / 31 / 202526It should be noted that connecting lines with or without arrows may be used in drawings to represent communication, transfer, or other activity involving two or more entities. Connecting lines with double-ended arrows generally indicate that activity may occur in both directions (e.g., a command / request in one direction with a corresponding reply back in the other direction, or peer-to-peer communications initiated by either entity), although in some situations, activity may not necessarily occur in both directions. Connecting lines with single-ended arrows generally indicate activity exclusively or predominantly in the direction of the arrow, although it should be noted that, in certain situations, such directional activity may involve activities in the opposite direction or in both directions (e.g., a message from a sender to a receiver and an acknowledgment back from the receiver to the sender, or establishment of a connection prior to a transfer and termination of the connection following the transfer). Thus, the type of arrow used in a particular drawing to represent a particular activity is exemplary and should not be seen as limiting.Connecting lines with no arrows can indicate activity in one, the other, or both directions as the context suggests. Dashed connecting lines may be used to represent optional or ancillary activities as the context suggests.Although the above discussion discloses various exemplary embodiments of the invention, it should be apparent that those skilled in the art can make various modifications that will achieve some of the advantages of the invention without departing from the true scope of the invention. Any references to the “invention” are intended to refer to exemplary embodiments of the invention and should not be construed to refer to all embodiments of the invention unless the context otherwise requires. The described embodiments are to be considered in all respects only as illustrative and not restrictive.

Claims

125757-10702-772270612 / 31 / 202527What is claimed is:

1. A net grid electrode assembly comprising:a net grid electrode substrate having an arrangement of openings forming a mesh configuration that can be draped over the prostate or other pelvic structure; a plurality of electrodes embedded in the net grid electrode substrate and placed in a regular or irregular pattern at intersection of the mesh; anda plurality of wire leads, each wire lead having a first portion embedded in the electrode base and a second portion extending from the electrode base, wherein each electrode is associated with a distinct one of the plurality of wire leads.

2. The assembly of claim 1, wherein the substrate is formed of a flexible material.

3. The assembly of claim 2, wherein the substrate is formed of silicone or polyurethane.

4. The assembly of claim 1, wherein the substrate has a thickness between around 0.3 mm to around 0.7 mm.

5. The assembly of claim 1, further comprising at least one forming structure on or embedded in the substrate for adding shape stability to the substrate.

6. The assembly of claim 5, wherein the at least one forming structure comprises wire.

7. The assembly of claim 1, wherein the electrodes are between around 1-2 mm in diameter and the inter-electrode distance is between around 2-3 mm center to center.

8. The assembly of claim 1, wherein the second portions of the plurality of wire leads are bundled into at least one wire bundle cable.125757-10702-772270612 / 31 / 2025289. The assembly of claim 8, wherein each wire bundle cable is shielded.

10. The assembly of claim 8, wherein each wire bundle cable ends in a communication interface.

11. The assembly of claim 10, wherein the communication interface comprises a touch-proof female plug.

12. The assembly of claim 8, wherein each wire bundle cable includes a sliding sleeve that gathers the wire leads.

13. The assembly of claim 12, wherein the sliding sleeve includes at least one suture hole.

14. The assembly of claim 1, wherein the substrate includes at least one suture hole.

15. The assembly of claim 1, wherein the substrate is formed from two layers of material.

16. The assembly of claim 15, wherein the plurality of electrodes are sandwiched between the two layers of material.

17. The assembly of claim 15, wherein the first portions of the plurality of wire leads are sandwiched between the two layers of material.

18. The assembly of claim 15, further comprising at least one forming structure sandwiched between the two layers of material.

19. The assembly of claim 1, wherein the substrate is separable into two or more parts, each part including at least one electrode and its corresponding wire lead.125757-10702-772270612 / 31 / 20252920. The assembly of claim 19, wherein the substrate include perforations for separating the substrate into the two or more parts.

21. The assembly of claim 1, wherein the openings are approximately 1 mm per side and the shape is a square or diamond shape.

22. The assembly of claim 1, wherein the substrate includes a central “fish net” matrix of the types described herein surrounded by four side lobes, a top lobe, and a bottom lobe, with stress-relief zones in between the lobes to result in a “butterfly” configuration that can conform to the top and sides of the prostate.

23. The assembly of claim 22, wherein the substrate includes suture holes along the lobe edges.

24. The assembly of claim 22, wherein the substrate includes electrodes that are positioned along the sides of the side lobes.

25. The assembly of claim 24, wherein the electrodes positioned along the sides of the side lobes include one or more rows of electrodes on each lobe.

26. The assembly of claim 24, wherein the electrodes positioned along the sides of the side lobes include a zig-zag pattern of electrodes on each side lobe.

27. The assembly of claim 22, including electrodes on the top lobe.

28. The assembly of claim 22, including electrodes on the bottom lobe.

29. The assembly of claim 22, including electrodes in the central “fish net” matrix.

30. The assembly of claim 1, wherein the substrate comprises a cruciform (e.g., X) shape.125757-10702-772270612 / 31 / 20253031. The assembly of claim 1, wherein the substrate comprises a stellate (e.g., star) shape.

32. The assembly of claim 1, wherein at least some of the openings have varying sizes and shapes along a curve.

33. A system comprising:a net grid electrode assembly according to any one of claims 1-32; and a controller in communication with the plurality of wire leads.

34. The system of claim 33, wherein the controller is configured to monitor signals from the electrodes and / or send signals to the electrodes.

35. The system of claim 34, wherein the controller is configured to use some electrodes to monitor and to use other electrodes to stimulate.

36. The system of claim 34, wherein the controller is configured to use at least one electrode for both monitoring and stimulating such as by alternating between monitoring and stimulating.

37. A method comprising:placing a net grid electrode assembly according to any one of claims 1-32 on a prostate;connecting the wire leads to a controller through one or more interfaces; and operating the controller to monitor and / or stimulate the prostate via the net grid electrode assembly.

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