V08-02: Robot-Assisted Radical Prostatectomy with 3D-based Augmented Reality
In surgery for PCa oncological and functional outcomes have gained equal importance. The implementation of minimally-invasive surgery by new technologies translated into a more tailored approach. However, the standard preoperative imaging still remains the routine for surgical planning and intraoperative decision-making. An intraoperative mental imagination by the surgeon is required. In order to avoid this “building in mind” process, 3D rendering with eventual intraoperative navigation are being introduced in the practice. In this study we present our first experience with augmented reality robot-assisted radical prostatectomy (AR-RARP)
From June to August 2017 all patients candidate for RARP were enrolled in this phase II study and underwent high resolution mpMRI (1 mm slices) according to a dedicated protocol. 3D reconstruction was performed by bioengineers. Thanks to a dedicated hardware and Tile-Pro, it was integrated inside the robotic console to perform AR-RARP. Patients were stratified according to the staging at MRI and reconstruction. In case of cT2 PCa intrafascial nerve sparing (NS) was scheduled. In such patients 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. AR-guided selective biopsy at the level of suspected extra-capsular extension (ECE) was performed. Prostate specimens were then scanned to assess the 3D model concordance.
30 patients were treated: 16 with Intrafascial NS (cT2) and 14 with Standard NS technique + selective biopsy of suspected ECE (cT3). Final pathology confirmed clinical staging. Positive surgical margins rate was 30%, with no positive surgical margins in pT2. In patients whose intraprostatic lesions were marked on the prostate capsule, final pathology confirmed lesion location. In patients with suspected ECE, AR-guided selective biopsies confirmed the correct location of the ECE. In 11/14 cases (78%) the biopsy was positive for PCa. Prostate specimens were scanned with finding of a good overlap. The mismatch between the 3D reconstruction and the scanning ranged from 1 to 5 mm. In the 85% of the entire surface the mismatch was
In our preliminary experience, AR-RARP seems to be safe and effective. The accuracy of 3D reconstruction was proven. This technology is not devoid of limitations: the 3D virtual models are manually oriented and rigid. Future collaborations between urologists and bioengineers will allow overcoming these limitations.