title: Real-time robotic transrectal ultrasound navigation during robotic radical prostatectomy: initial clinical experience.
abstract: OBJECTIVE
  To describe a novel robotic transrectal ultrasound platform for real-time navigation during robot-assisted laparoscopic radical prostatectomy (RALP) and to report its early clinical application.
  
  
  METHODS
  Five men undergoing RALPs at our Institution agreed to participate in this Institutional Review Board-approved pilot study. All of them were eligible for a bilateral nerve sparing procedure. Before docking the da Vinci robot, a transrectal ultrasound tri-plane side-fire probe was placed. A modified ViKY Endoscope Holder was used during RALPs to move the probe thanks to a remote control placed under the console surgeon's control during RALPs. During each procedure, attempt was made to estimate prostate volume, define 12 reference points, and to precisely identify location of the neurovascular bundles using Doppler ultrasound. The TilePro was used during the procedures to allow real-time ultrasound imaging to guide robotic instruments during dissection.
  
  
  RESULTS
  Median robotic transrectal ultrasound probe holder (R-TRUS) setup time was 11 minutes (interquartile range [IQR], 10-14). Prostate volume calculation, reference point definition, neurovascular bundle identification, and instrument tip visualization were successful in all men. In 1 patient with a large prostate (120 mL), R-TRUS was withdrawn during recto-prostatic dissection. There were no rectal injuries.
  
  
  CONCLUSIONS
  R-TRUS during RALPs is feasible and safe. It allows real-time TRUS navigation and guidance. Further studies are needed to evaluate its impact on oncological and functional outcomes.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Byron H
authors.initials: BH
authors.lastname: Lee
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Rachid
authors.initials: R
authors.lastname: Yakoubi
authors.forename: Emad
authors.initials: E
authors.lastname: Rizkala
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
mesh_terms: D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012007:Rectum; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000295:instrumentation