Tandem-robot assisted laparoscopic radical prostatectomy to improve the neurovascular bundle visualization: a feasibility study.
OBJECTIVE
To examine the feasibility of image-guided navigation using transrectal ultrasound (TRUS) to visualize the neurovascular bundle (NVB) during robot-assisted laparoscopic radical prostatectomy (RALP). The preservation of the NVB during radical prostatectomy improves the postoperative recovery of sexual potency. The accompanying blood vessels in the NVB can serve as a macroscopic landmark to localize the microscopic cavernous nerves in the NVB.


METHODS
A novel, robotic transrectal ultrasound probe manipulator (TRUS Robot) and three-dimensional (3-D) reconstruction software were developed and used concurrently with the daVinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA) in a tandem-robot assisted laparoscopic radical prostatectomy (T-RALP).


RESULTS
After appropriate approval and informed consent were obtained, 3 subjects underwent T-RALP without associated complications. The TRUS Robot allowed a steady handling and remote manipulation of the TRUS probe during T-RALP. It also tracked the TRUS probe position accurately and allowed 3-D image reconstruction of the prostate and surrounding structures. Image navigation was performed by observing the tips of the daVinci surgical instruments in the live TRUS image. Blood vessels in the NVB were visualized using Doppler ultrasound.


CONCLUSIONS
Intraoperative 3-D image-guided navigation in T-RALP is feasible. The use of TRUS during radical prostatectomy can potentially improve the visualization and preservation of the NVB. Further studies are needed to assess the clinical benefit of T-RALP.
James Buchanan Brady Urological Institute, Urology Robotics Laboratory, Baltimore, Maryland 21287, USA. mhan1@jhmi.edu
Misop
M
Han
Chunwoo
C
Kim
Pierre
P
Mozer
Felix
F
Schäfer
Shadie
S
Badaan
Bogdan
B
Vigaru
Kenneth
K
Tseng
Doru
D
Petrisor
Bruce
B
Trock
Dan
D
Stoianovici
D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging* / Q000294:innervation*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation; D018084:Ultrasonography, Interventional