Three-dimensional surgical navigation model with TilePro display during robot-assisted radical prostatectomy.
Abstract To facilitate robotic nerve-sparing radical prostatectomy, we developed a novel three-dimensional (3D) surgical navigation model that is displayed on the TilePro function of the da Vinci® surgeon console. Based on 3D transrectal ultrasonography (TRUS)-guided prostate biopsies, we reconstructed a 3D model of the TRUS-visible, histologically confirmed "index" cancer lesion in 10 consecutive patients. Five key anatomic structures (prostate, image-visible biopsy-proven "index" cancer lesion, neurovascular bundles, urethra, and recorded biopsy trajectories) were image-fused and displayed onto the TilePro function of the robotic console. The 3D model facilitated careful surgical dissection in the vicinity of the biopsy-proven index lesion. Geographic location of the index lesion on the final histology report correlated with the software-created 3D model. Negative surgical margins were achieved in 90%, except for one case with extensive extra-prostate extension. At postoperative 3 months, prostate-specific antigen levels were undetectable (<0.03 ng/mL) in all cases. The initial experience of the navigation model is presented.
Center of Image-Guided Surgery and Robotic Surgery, USC Institute of Urology, Keck School of Medicine, University of Southern California , Los Angeles, California.
Osamu
O
Ukimura
Monish
M
Aron
Masahiko
M
Nakamoto
Sunao
S
Shoji
Andre Luis de Castro
AL
Abreu
Toru
T
Matsugasumi
Andre
A
Berger
Mihir
M
Desai
Inderbir S
IS
Gill
D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D008953:Models, Anatomic; D060787:Neoplasm Grading; D059351:Organ Sparing Treatments / Q000379:methods*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014521:Urethra / Q000601:surgery
D017430:Prostate-Specific Antigen