Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Prostatectomy on Trifecta Outcomes: A Randomized Clinical Trial.

Planning complex operations such as robotic-assisted radical prostatectomy requires surgeons to review 2-dimensional magnetic resonance imaging (MRI) cross-sectional images to understand 3-dimensional (3D), patient-specific anatomy. We sought to determine surgical outcomes for robotic-assisted radical prostatectomy when surgeons reviewed 3D, virtual reality (VR) models for operative planning.

A multicenter, randomized, single-blind clinical trial was conducted from January 2019 to December 2020. Patients undergoing robotic-assisted prostatectomy were prospectively enrolled and randomized to either a control group undergoing usual preoperative planning with prostate biopsy results and MRI only or to an intervention group where MRI and biopsy results were supplemented with a 3D VR model. The primary outcome measure was margin status, and secondary outcomes were oncologic control, sexual function and urinary function.

Ninety-two patients were analyzed, with trends toward lower positive margin rates (33% vs 25%) in the intervention group compared to the control group, no significant difference in functional outcomes and no difference in traditional operative metrics (p >0.05). Detectable postoperative prostate specific antigen was significantly lower in the intervention group (31% vs 9%, p=0.036). In 32% of intervention cases, the surgeons modified their operative plan based on the model. When this subset was compared to the control group, there was a strong trend toward increased bilateral nerve sparing in the intervention subset (78% vs 92%), and a significant difference in postoperative detectable prostate specific antigen (31% vs 0%, p=0.038).

This randomized clinical trial demonstrated patients whose surgical planning involved 3D VR models have better oncologic outcomes while maintaining functional outcomes.

The Journal of urology. 2022 Jul 18 [Epub ahead of print]

Joseph D Shirk, Robert Reiter, Eric M Wallen, Ray Pak, Thomas Ahlering, Ketan K Badani, James R Porter

Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California., Department of Urology, UNC Chapel Hill School of Medicine, Chapel Hill, North Carolina., Department of Urology, Mayo Clinic Florida, Jacksonville, Florida., Department of Urology, University of California-Irvine, Irvine, California., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York., Swedish Medical Center, Seattle, Washington.

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