WCE 2017: Image-Guided Therapy
Dr. Ardeshir Rastinehad presented on the use of fusion imaging to improve biopsies of the prostate for the treatment of prostate cancer. By combining MRI and ultrasound (US), they not only created a better fusion image to plan their procedure, but also created a better guiding tool when used intraoperatively for navigation. Fusion imaging has also added more data for the Da Vinci to use, allowing a better 3D MR model to be used for surgical planning.
Dr. Burnolf Lagerveld presented on the use of computed tomography (CT) to improve cryoablation in treating small renal masses. He began by stating the benefit of cryoablation for patients with increased comorbidity, old age, or decreased renal function. He then stated how some limitations of cryoablation is due to data supporting its benefits being limited by poor histology reports and a lack of long term follow up reports. Dr. Lagerveld believes with a stronger emphasis and monitoring of small renal masses following cryoablation, this technique can be utilized more for treating malignant lesions of the kidney with a lower complication rate.
Dr. Rolf Muschter presented on the benefits of concurrent use of a photosensitizer agent called TOOKAD and photodynamic therapy (PDT) in treating prostate cancer. First, the TOOKAD is introduced by intravenous injection, allowing it to travel to the area of interest. Then, a light is applied at near infrared wavelength onto the tumor, activating the photosensitizer agent present on the mass. This causes the release of a type of oxygen toxic to cancer cells, treating the prostate tumor. He concluded this method of PDT with TOOKAD is a suitable, safe, and effective treatment for low risk prostate cancer.
Dr. Joseph Chin presented on the use of High Intensity Focused Ultrasound (HIFU) in treating prostate cancer. He began by describing how because one can modify the duration of sonication and power, one can treat these small masses with greater surgical precision. Dr. Chin then discussed how limitations of HIFU was due to a lack of published randomized trials and long term data regarding oncologic efficacy of the procedure. He hopes to address this by continuing to treat prostate cancer with HIFU per patient's consent to further explore the benefits and risks of this procedure.
Dr. Stanley Herrell presented on the basics of image guidance and how different imaging techniques can affect one’s navigation in renal surgery. He began by defining active navigation as real time imaging with fluoroscopy, ultrasound, and MRI intra-operatively. Passive navigation was defined as using the images outside of the OR to plan the surgery preoperatively. He then stated how the rising use of augmented reality could possibly allow better navigation during renal surgery. Due to the imaging technique integrating a better registration of the 3D coordination of physical space to image space and allowing better localization and display of the surgeon’s tools, he believes treating small renal masses will have more surgical precision compared to the previous imaging techniques.
Presented by: Jeffrey Cadeddu, MD, Ardeshir Rastinehad, Burnolf Lagerveld, Rolf Muschter, Joseph Chin, Stanley Herrell
Affiliation: Department of Urology and Radiology, University of Texas Southwestern, Dallas, Texas
Written by: Cyrus Lin, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.