Augmented Reality Robot-assisted Radical Prostatectomy: Preliminary Experience.

Abstract

OBJECTIVE:

To present our preliminary experience with augmented reality robot-assisted radical prostatectomy (AR-RARP).

MATERIALS:

From June to August 2017, patients candidate to RARP were enrolled and underwent high-resolution multi-parametric magnetic resonance imaging (1-mm slices) according to dedicated protocol. The obtained three-dimensional (3D) reconstruction was integrated in the robotic console to perform AR-RARP. According to the staging at magnetic resonance imaging or reconstruction, in case of cT2 prostate cancer, intrafascial nerve sparing (NS) was performed: a mark was placed on the prostate capsule to indicate the virtual underlying intraprostatic lesion; in case of cT3, standard NS AR-RARP was scheduled with AR-guided biopsy at the level of suspected extracapsular extension (ECE). Prostate specimens were scanned to assess the 3D model concordance.

RESULTS:

Sixteen patients underwent intrafascial NS technique (cT2), whereas 14 underwent standard NS+ selective biopsy of suspected ECE (cT3). Final pathology confirmed clinical staging. Positive surgical margins' rate was 30% (no positive surgical margins in pT2). In patients whose intraprostatic lesions were marked, final pathology confirmed lesion location. In patients with suspected ECE, AR-guided selective biopsies confirmed the ECE location, with 11 of 14 biopsies (78%) positive for prostate cancer. Prostate specimens were scanned with finding of a good overlap. The mismatch between 3D reconstruction and scanning ranged from 1 to 5 mm. In 85% of the entire surface, the mismatch was <3 mm.

CONCLUSION:

In our preliminary experience, AR-RARP seems to be safe and effective. The accuracy of 3D reconstruction seemed to be promising. This technology has still limitations: the virtual models are manually oriented and rigid. Future collaborations with bioengineers will allow overcoming these limitations.

• Authors: Francesco Porpiglia, Cristian Fiori, Enrico Checcucci, Daniele Amparore, Riccardo Bertolo
• Journal: Urology (Urology) Vol. 115 Pg. 184 (May 2018) ISSN: 1527-9995 [Electronic] United States
• PMID: 29548868 (Publication Type: Journal Article, Video-Audio Media)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Humans
• Imaging, Three-Dimensional
• Magnetic Resonance Imaging
• Male
• Neoplasm Staging
• Organ Culture Techniques
• Peripheral Nerves
• Prostatectomy (methods)
• Prostatic Neoplasms (diagnostic imaging, pathology, surgery)
• Robotic Surgical Procedures (methods)