title: Intraoperative registered transrectal ultrasound guidance for robot-assisted laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To provide unencumbered real-time ultrasound image guidance during robot-assisted laparoscopic radical prostatectomy, we developed a robotic transrectal ultrasound system that tracks the da Vinci® Surgical System instruments. We describe our initial clinical experience with this system.
  
  
  METHODS
  After an evaluation in a canine model, 20 patients were enrolled in the study. During each procedure the transrectal ultrasound transducer was manually positioned using a brachytherapy stabilizer to provide good imaging of the prostate. Then the transrectal ultrasound was registered to the da Vinci robot by a previously validated procedure. Finally, automatic rotation of the transrectal ultrasound was enabled such that the transrectal ultrasound imaging plane safely tracked the tip of the da Vinci instrument controlled by the surgeon, while real-time transrectal ultrasound images were relayed to the surgeon at the da Vinci console. Tracking was activated during all critical stages of the surgery.
  
  
  RESULTS
  The transrectal ultrasound robot was easy to set up and use, adding 7 minutes (range 5 to 14) to the procedure. It did not require an assistant or additional control devices. Qualitative feedback was acquired from the surgeons, who found transrectal ultrasound useful in identifying the urethra while passing the dorsal venous complex suture, defining the prostate-bladder interface during bladder neck dissection, identifying the seminal vesicles and their location with respect to the rectal wall, and identifying the distal prostate boundary at the apex.
  
  
  CONCLUSIONS
  Real-time, registered robotic transrectal ultrasound guidance with automatic instrument tracking during robot-assisted laparoscopic radical prostatectomy is feasible and potentially useful. The results justify further studies to establish whether the approach can improve procedure outcomes.
authors.affiliation: Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Omid
authors.initials: O
authors.lastname: Mohareri
authors.affiliation: University of Melbourne, Melbourne, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ischia
authors.affiliation: Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
authors.affiliation: Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Schneider
authors.affiliation: Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Julio
authors.initials: J
authors.lastname: Lobo
authors.affiliation: Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Goldenberg
authors.affiliation: Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Septimiu E
authors.initials: SE
authors.lastname: Salcudean
mesh_terms: D000368:Aged; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012007:Rectum; D065287:Robotic Surgical Procedures; D025321:Surgery, Computer-Assisted; D018084:Ultrasonography, Interventional / Q000379:methods
keywords: laparoscopy; prostatectomy; prostatic neoplasms; robotics; ultrasonography