3D reconstruction of the standard two-dimension cross-sectional imaging has known increasing diffusion. It may represent one of the key points for a tailored treatment planning. Along these lines, we used a novel software for augmented-reality robot-assisted radical prostatectomy (AR-RARP) at our Institution. 3D virtual models of the prostate and the prostate cancer were reconstructed from high resolution (1-mm slices) multi-parametric Magnetic Resonance Imaging (mp-MRI) by M3dics (Turin, Italy). The innovation in the study is represented by the software-based integration of the virtual model inside the Da Vinci (Intuitive, Sunnyvale, CA, USA) robotic console during robotic prostatectomy. In January 2018, the above-described AR-RARP technique has been used during the live surgery sessions of the 6th Techno-Urology Meeting held at San Luigi Gonzaga Hospital (Orbassano, Turin, Italy). During this meeting, 6 experienced robotic surgeons (who have already performed more than 1000 RARP) used the software during nerve-sparing prostatectomy. The use of the technology was standardized to four key steps during the procedure: 1) bladder neck dissection; 2) nerve-sparing technique; 3) apex dissection; and 4) tailoring of eventual selective biopsies of prostatic lodge after prostatectomy). A Face Validity questionnaire was purpose-built aimed to collect the expert surgeons' insights about the eventual help of the technology in guiding the surgeon during the above-described AR-RARP steps. It was administered at the end of the surgeries to the respective surgeons. The questionnaire was made of open-ended questions of ordinal ten-point rating Likert Scale (where 1 corresponded to a strongly negative opinion and 10 to a strongly positive opinion). The median value of Likert scale from the evaluation of each of the aforementioned steps of AR-RARP was 9, (IQR 9-10). These findings are a confirmation of the increasing interest for a new-generation of image-guided surgery. Particularly, AR-RARP seems to be a step in the direction of "precision" surgery.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2018 Apr [Epub]
Francesco Porpiglia, Riccardo Bertolo, Daniele Amparore, Enrico Checcucci, Walter Artibani, Prokar Dasgupta, Francesco Montorsi, Ashutosh Tewari, Cristian Fiori, ESUT
Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy - ., Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., Department of Urology, G.B. Rossi Polyclinic, University of Verona, Verona, Italy., Department of Urology, King's College London, Guy's Hospital, London, UK., Department of Urology, Vita Salute San Raffaele University, Milan, Italy., Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.