Riccardo Schiavina1, Lorenzo Bianchi2, Simone Lodi3, Laura Cercenelli4, Francesco Chessa1, Barbara Bortolani5, Caterina Gaudiano6, Carlo Casablanca7, Matteo Droghetti7, Angelo Porreca8, Daniele Romagnoli8, Rita Golfieri6, Francesca Giunchi9, Michelangelo Fiorentino9, Emanuela Marcelli3, Stefano Diciotti10, Eugenio Brunocilla1. 1. Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy. 2. Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy. Electronic address: lorenzo.bianchi3@gmail.com. 3. Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy. 4. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. 5. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy. 6. Radiology Unit, Department of Diagnostic Medicine and Prevention, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia. 7. Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia. 8. Department of Urology, Abano Terme Hospital, Padua, Italy. 9. Pathology Department Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia. 10. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
Abstract
BACKGROUND: Augmented reality (AR) is a novel technology adopted in prostatic surgery. OBJECTIVE: To evaluate the impact of a 3D model with AR (AR-3D model), to guide nerve sparing (NS) during robot-assisted radical prostatectomy (RARP), on surgical planning. DESIGN, SETTING, AND PARTICIPANTS: Twenty-six consecutive patients with diagnosis of prostate cancer (PCa) and multiparametric magnetic resonance imaging (mpMRI) results available were scheduled for AR-3D NS RARP. INTERVENTION: Segmentation of mpMRI and creation of 3D virtual models were achieved. To develop AR guidance, the surgical DaVinci video stream was sent to an AR-dedicated personal computer, and the 3D virtual model was superimposed and manipulated in real time on the robotic console. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The concordance of localisation of the index lesion between the 3D model and the pathological specimen was evaluated using a prostate map of 32 specific areas. A preliminary surgical plan to determinate the extent of the NS approach was recorded based on mpMRI. The final surgical plan was reassessed during surgery by implementation of the AR-3D model guidance. RESULTS AND LIMITATIONS: The positive surgical margin (PSM) rate was 15.4% in the overall patient population; three patients (11.5%) had PSMs at the level of the index lesion. AR-3D technology changed the NS surgical plan in 38.5% of men on patient-based and in 34.6% of sides on side-based analysis, resulting in overall appropriateness of 94.4%. The 3D model revealed 70%, 100%, and 92% of sensitivity, specificity, and accuracy, respectively, at the 32-area map analysis. CONCLUSIONS: AR-3D guided surgery is useful for improving the real-time identification of the index lesion and allows changing of the NS approach in approximately one out of three cases, with overall appropriateness of 94.4%. PATIENT SUMMARY: Augmented reality three-dimensional guided robot-assisted radical prostatectomy allows identification of the index prostate cancer during surgery, to tailor the surgical dissection to the index lesion and to change the extent of nerve-sparing dissection.
BACKGROUND: Augmented reality (AR) is a novel technology adopted in prostatic surgery. OBJECTIVE: To evaluate the impact of a 3D model with AR (AR-3D model), to guide nerve sparing (NS) during robot-assisted radical prostatectomy (RARP), on surgical planning. DESIGN, SETTING, AND PARTICIPANTS: Twenty-six consecutive patients with diagnosis of prostate cancer (PCa) and multiparametric magnetic resonance imaging (mpMRI) results available were scheduled for AR-3D NS RARP. INTERVENTION: Segmentation of mpMRI and creation of 3D virtual models were achieved. To develop AR guidance, the surgical DaVinci video stream was sent to an AR-dedicated personal computer, and the 3D virtual model was superimposed and manipulated in real time on the robotic console. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The concordance of localisation of the index lesion between the 3D model and the pathological specimen was evaluated using a prostate map of 32 specific areas. A preliminary surgical plan to determinate the extent of the NS approach was recorded based on mpMRI. The final surgical plan was reassessed during surgery by implementation of the AR-3D model guidance. RESULTS AND LIMITATIONS: The positive surgical margin (PSM) rate was 15.4% in the overall patient population; three patients (11.5%) had PSMs at the level of the index lesion. AR-3D technology changed the NS surgical plan in 38.5% of men on patient-based and in 34.6% of sides on side-based analysis, resulting in overall appropriateness of 94.4%. The 3D model revealed 70%, 100%, and 92% of sensitivity, specificity, and accuracy, respectively, at the 32-area map analysis. CONCLUSIONS: AR-3D guided surgery is useful for improving the real-time identification of the index lesion and allows changing of the NS approach in approximately one out of three cases, with overall appropriateness of 94.4%. PATIENT SUMMARY: Augmented reality three-dimensional guided robot-assisted radical prostatectomy allows identification of the index prostate cancer during surgery, to tailor the surgical dissection to the index lesion and to change the extent of nerve-sparing dissection.
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Authors: Laura Cercenelli; Alessia De Stefano; Anna Maria Billi; Alessandra Ruggeri; Emanuela Marcelli; Claudio Marchetti; Lucia Manzoli; Stefano Ratti; Giovanni Badiali Journal: Int J Environ Res Public Health Date: 2022-01-18 Impact factor: 3.390
Authors: Benedikt Hoeh; Mike Wenzel; Lukas Hohenhorst; Jens Köllermann; Markus Graefen; Alexander Haese; Derya Tilki; Jochen Walz; Marina Kosiba; Andreas Becker; Severine Banek; Luis A Kluth; Philipp Mandel; Pierre I Karakiewicz; Felix K H Chun; Felix Preisser Journal: Front Surg Date: 2022-02-22
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