Augmented-reality robot-assisted radical prostatectomy using hyper-accuracy three-dimensional reconstruction (HA3D™) technology: a radiological and pathological study.
作者： Francesco Porpiglia , Enrico Checcucci , Daniele Amparore , Riccardo Autorino , Alberto Piana
DOI: 10.1111/BJU.14549
关键词: Neurovascular bundle 、 Virtual image 、 Prostate 、 Multiparametric Magnetic Resonance Imaging 、 3D reconstruction 、 Prostate cancer 、 Prostatectomy 、 Radiology 、 Medicine 、 Index Lesion
摘要: Objectives To assess the use of hyper-accuracy three-dimensional (HA3D™; MEDICS, Moncalieri, Turin, Italy) reconstruction based on multiparametric magnetic resonance imaging (mpMRI) and superimposed during augmented-reality robot-assisted radical prostatectomy (AR-RARP). Patients methods with prostate cancer (clinical stages cT1-3, cN0, cM0) undergoing RARP at our Centre, from June 2017 to April 2018, were enrolled. In all cases, was diagnosed targeted biopsy level index lesion high-resolution (1-mm slices) mpMRI. HA3D created by dedicated software obtain 3D virtual model surrounding structures. A specific system used overlay data endoscopic video displayed remote da Vinci® surgical console (Intuitive Surgical Inc., Sunnyvale, CA, USA), images surgeon means TilePro™ multi-input display technology Inc.). The AR in four standardised key steps RARP. procedures modulated differently cases without extracapsular extension (ECE) mpMRI (Group A) or ECE B) Group A, image overlaid view intraprostatic marked surface a metallic clip suspicious as identified image. B, same step performed; moreover, placed neurovascular bundles (NVBs) according images. Finally, selective biopsies taken NVBs this level, then, entire removed for final pathological examination, standard clinical indications. For pathologist performed needle before sample reduction. presence tumour evaluated reduction phase, NVBs, sent separately. an scanner (Kinect, Microsoft) perform dimensional comparison between mpMRI-based whole-mount specimen. Results all, 30 patients enrolled present study, 11 (36.6%) included 19 (63.4%) B. (30/30), pathology confirmed location lesion, found clip. suspected 15/19 (79%). AR-guided location, 11/15 (73.3%) positive cancer. mismatch scanning specimen 85% gland. Conclusion Our results suggest that real-time allow performance effective AR-RARP. Potentially, approach translates into better outcomes, can tailor procedure each patient.
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