Three-dimensional Elastic Augmented-reality Robot-assisted Radical Prostatectomy Using Hyperaccuracy Three-dimensional Reconstruction Technology: A Step Further in the Identification of Capsular Involvement

In prostate cancer (PCa) surgical procedures, in order to maximize potency recovery, a nerve-sparing (NS) procedure is preferred. However, cancer abutting or focally extending beyond the prostate capsule increases the risk of a positive surgical margin. To evaluate the accuracy of our new three-dime...

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Bibliographic Details
Published in:European urology 2019-10, Vol.76 (4), p.505-514
Main Authors: Porpiglia, Francesco, Checcucci, Enrico, Amparore, Daniele, Manfredi, Matteo, Massa, Federica, Piazzolla, Pietro, Manfrin, Diego, Piana, Alberto, Tota, Daniele, Bollito, Enrico, Fiori, Cristian
Format: Article
Language:English
Subjects:
Aged
Augmented Reality
Elasticity
Humans
Hyperaccuracy three-dimensional reconstruction
Image Processing, Computer-Assisted
Image-guided surgery
Imaging, Three-Dimensional
Male
Middle Aged
Prospective Studies
Prostatectomy
Prostatectomy - methods
Prostatic Neoplasms - diagnostic imaging
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Robotic Surgical Procedures
Robotics
Surgery, Computer-Assisted
Three-dimensional reconstruction
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Summary:In prostate cancer (PCa) surgical procedures, in order to maximize potency recovery, a nerve-sparing (NS) procedure is preferred. However, cancer abutting or focally extending beyond the prostate capsule increases the risk of a positive surgical margin. To evaluate the accuracy of our new three-dimensional (3D) elastic augmented-reality (AR) system in identifying capsular involvement (CI) location of PCa during the NS phase of robot-assisted radical prostatectomy (RARP). Secondarily, the accuracy of this technology was compared with two-dimensional (2D)-based cognitive procedures. A prospective study, enrolling 40 patients with PCa undergoing RARP at our center, from May to October 2018. Patients underwent 3D AR RARP or, in case of unavailability of this technology, 2D cognitive RARP. In all patients, total anatomical reconstruction was used. Clinical data were collected. In order to compare the two groups, nonparametric Mann-Whitney and chi-square tests were performed. A metallic clip was placed at the level of suspicious CI on the basis of images given by the 3D AR or magnetic resonance imaging (MRI) report. The pathological analysis evaluated the presence of tumor at the level of the clip. Twenty patients were enrolled in each group. Focusing on the 3D AR group at macroscopic evaluation, the metallic clip was placed at the tumor and capsular bulging in all cases. At microscopic assessment, cancer presence was confirmed in the suspicious area in 95.4% of the cases. Moreover, CI was correctly identified in 100.0% of the cases, thanks to the 3D image overlap. These results were compared with the 2D MRI cognitive group, showing, at microscopic analysis, statistically significant superiority of the 3D AR group in CI detection during the NS phase (100% vs 47.0%; p
ISSN:0302-2838
1873-7560
DOI:10.1016/j.eururo.2019.03.037