Joshua Makary1,2,3,4, Danielle C van Diepen5,6,7, Ranjan Arianayagam8, George McClintock8, Jeremy Fallot5,8,9, Scott Leslie5,10,8,9, Ruban Thanigasalam5,6,10,8,9. 1. Royal Prince Alfred Institute of Academic Surgery, Camperdown, Sydney, NSW, 2050, Australia. Joshua.Makary@health.nsw.gov.au. 2. Concord Repatriation General Hospital, Sydney, NSW, Australia. Joshua.Makary@health.nsw.gov.au. 3. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Joshua.Makary@health.nsw.gov.au. 4. Chris O'Brien Lifehouse, Sydney, NSW, Australia. Joshua.Makary@health.nsw.gov.au. 5. Royal Prince Alfred Institute of Academic Surgery, Camperdown, Sydney, NSW, 2050, Australia. 6. Concord Repatriation General Hospital, Sydney, NSW, Australia. 7. Erasmus MC Cancer Institute, Erasmus University, Rotterdam, South Holland, The Netherlands. 8. Chris O'Brien Lifehouse, Sydney, NSW, Australia. 9. Royal Prince Alfred Hospital, Sydney, NSW, Australia. 10. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Abstract
OBJECTIVES: To describe the innovative intraoperative technologies emerging to aid surgeons during minimally invasive robotic-assisted laparoscopic prostatectomy. METHODS: We searched multiple electronic databases reporting on intraoperative imaging and navigation technologies, robotic surgery in combination with 3D modeling and 3D printing used during laparoscopic or robotic-assisted laparoscopic prostatectomy. Additional searches were conducted for articles that considered the role of artificial intelligence and machine learning and their application to robotic surgery. We excluded studies using intraoperative navigation technologies during open radical prostatectomy and studies considering technology to visualize lymph nodes. Intraoperative imaging using either transrectal ultrasonography or augmented reality was associated with a potential decrease in positive surgical margins rates. Improvements in detecting capsular involvement may be seen with augmented reality. The benefit, feasibility and applications of other imaging modalities such as 3D-printed models and optical imaging are discussed. CONCLUSION: The application of image-guided surgery and robotics has led to the development of promising new intraoperative imaging technologies such as augmented reality, fluorescence imaging, optical coherence tomography, confocal laser endomicroscopy and 3D printing. Currently challenges regarding tissue deformation and automatic tracking of prostate movements remain and there is a paucity in the literature supporting the use of these technologies. Urologic surgeons are encouraged to improve and test these advanced technologies in the clinical arena, preferably with comparative, randomized, trials.
OBJECTIVES: To describe the innovative intraoperative technologies emerging to aid surgeons during minimally invasive robotic-assisted laparoscopic prostatectomy. METHODS: We searched multiple electronic databases reporting on intraoperative imaging and navigation technologies, robotic surgery in combination with 3D modeling and 3D printing used during laparoscopic or robotic-assisted laparoscopic prostatectomy. Additional searches were conducted for articles that considered the role of artificial intelligence and machine learning and their application to robotic surgery. We excluded studies using intraoperative navigation technologies during open radical prostatectomy and studies considering technology to visualize lymph nodes. Intraoperative imaging using either transrectal ultrasonography or augmented reality was associated with a potential decrease in positive surgical margins rates. Improvements in detecting capsular involvement may be seen with augmented reality. The benefit, feasibility and applications of other imaging modalities such as 3D-printed models and optical imaging are discussed. CONCLUSION: The application of image-guided surgery and robotics has led to the development of promising new intraoperative imaging technologies such as augmented reality, fluorescence imaging, optical coherence tomography, confocal laser endomicroscopy and 3D printing. Currently challenges regarding tissue deformation and automatic tracking of prostate movements remain and there is a paucity in the literature supporting the use of these technologies. Urologic surgeons are encouraged to improve and test these advanced technologies in the clinical arena, preferably with comparative, randomized, trials.
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