V1268: Novel surgical tile-pro navigation with 3D prostate cancer model during robot-assisted radical prostatectomy

Video

Introduction and Objectives
To demonstrate a novel surgical navigation system using three-dimensional (3D) prostate cancer (PCa) model, shown in the “Tile-pro display” of da Vinci® surgical system during robot-assisted radical prostatectomy (RARP), based on use of our cutting-edge technology of the image-based 3D mapping technology.

Methods
The biopsy-proven image-visible 3D cancer model was reconstructed from 0.3 mm step sectional transrectal ultrasound (TRUS), which were acquired in our routine outpatient biopsy protocol of “real-time TRUS-MRI fusion-based 3D cancer mapping technique (Urostation®, Koelis)”. Since we have orientation of the biopsy specimens by inking technique of the distal end, the actual cancer location and length on each core were color-coded in red, while benign in green. Based on digitalized 3D data, our software fused surface rendered 3D models in five key anatomic aspects, including the prostate, image-visible biopsy-proven cancer, neurovascular bundles (NVB), urethra, and color-coded biopsy trajectories. The model was then shown in the “Tile-pro display” during RARP. Intra-operatively the 3D model was tracked according to the surgeon’s view real-timely. 10 patients with localized PCa, median PSA 6.7 ng/ml and Gleason score 7 (6-8) underwent RARP with the navigation system.

Results
Navigation: The “tile-pro” 3D navigation provided location and risk of extra-prostatic extension of the biopsy-proven cancer beyond the surgical view (Figure) to achieve negative surgical margin in 90% except one case with extensive pT3a disease. Cancer location on the 3D model of the index lesion matched (100%) with final pathology. It facilitated intra-operative planning and decision making of complete/partial nerve sparing or sacrificing the NVB at specific location. Perioperative: There were no perioperative complications, the median estimated blood loss, operative time and hospital stay were was 100 ml, 180 min and 2 days respectively.

Conclusions
3D surgical navigation in “Tile-pro display” precisely identified the 3D location of biopsy-proven cancer beyond the surgical view, to facilitate careful surgical dissection adjacent to the index cancer to achieve negative surgical margins.

Funding: None