V12-06: Implementation of Multiparametric Magnetic Resonance Imaging into Robotic – Assisted Radical Prostatectomy Using Virtual Reality
Multiparametric magnetic resonance imaging (mpMRI) of the prostate has been proven to improve cancer detection and staging. It has been more commonly used during urology practice at several stages of urologic management, one of which is pre-surgical planning. Currently, urologists check mpMRI data at picture archiving and storing systems (PACS) before or during robotic-assisted radical prostatectomy (RARP) to deliver better care. In this video, we demonstrate implementation of mpMRI data into intraoperative stereo imaging during a laparoscopic RARP procedure using the da Vinci® surgical system in 72-year-old patient with Gleason 4+4 prostate cancer (PCa).
mpMRI revealed a 1.8cm tumor in the left apical-mid peripheral zone which was assigned a category 5 according to the Prostate Imaging-Reporting and Data System version 2. The lesion showed aggressive features with possible extraprostatic extension and invasion of the left neurovascular bundle (NVB). T2W MRI component of mpMRI was utilized to create 3D models of the prostate, bladder, rectum, NVBs, seminal vesicles, urethra and PCa lesions by manually contouring process. These contours were then used to create 3D mesh models for a commercially available VR platform with head mounted display (HMD) and touch controls (Oculus Rift®). Prior to RARP procedure, surgeons checked the MRI derived 3D model of prostate and its surrounding anatomy. During RARP, stereo images of the laparoscopic views were extracted using the da Vinci® DVI outputs. Both models were then aligned to each other using an in-house algorithm and provided to urologists during RARP.
Invivo imaging derived 3D models of the prostate, index lesion and periprostatic anatomy was successfully delivered to urologist during RARP procedure. This interactive visualization method enabled the surgeon to conduct a wider excision of the NVB at this spot without increasing the procedure&[prime]s time significantly. The final histopathology revealed clean margins at the wide excision zone.
Realtime use of in-vivo mpMRI derived 3D prostate and periprostatic anatomy information during laparoscopic RARP procedure via the da Vinci® surgical system can be advantageous to better tailor the surgery procedure and can potentially improve spatial awareness.
Funding: The author&[prime]s postdoctoral fellowship is funded by a research grant from the &[Prime]Dr. Mildred Scheel&[Prime] foundation (Bonn, Germany) The research in this study was funded by the Intramural Research Program of the National Institutes of Health