Aron Monish, Kaouk Jihad H, Hegarty Nicholas J, Colombo Jose Roberto, Haber Georges-Pascal, Chung Benjamin I, Zhou Ming, Gill Inderbir S
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44115, USA.
J Endourol. 2007 Aug;21(8):814-8. doi: 10.1089/end.2006.9938.
To evaluate the feasibility of high-resolution optical coherence tomography (OCT) in the identification of neurovascular bundles (NVBs) during laparoscopic and robotic radical prostatectomy (LRP).
Between November 2005 and March 2006, 24 patients undergoing transperitoneal laparoscopic or robotic radical prostatectomy were enrolled in this study. Once the bladder was taken down and the prostate mobilized, the Niris imaging system was deployed. In each patient, in-vivo images were obtained to determine the image characteristics of NVBs, adipose tissue, prostate capsule, and endopelvic fascia. The NVB was imaged again in vivo, after the prostate was excised. Ex-vivo images were obtained from the prostate surface to look for the presence or absence of the NVBs and correlated with the surgeon's assessment of the adequacy of nerve sparing.
From 24 patients, we obtained more than 300 OCT images of tissue structures including endopelvic fascia, prostate capsule, NVBs, fat, lateral pedicles, and lymphatics. These images were found to correlate independently with the surgeon's impression of the tissue being imaged. Preliminary comparison with parallel histologic evaluation was performed in four patients that suggested OCT could help to identify the NVBs and prostate capsule during LRP.
In our preliminary experience with the Niris system during LRP, OCT was able to image the NVB in all patients. This could enhance surgical precision during nerve sparing and positively impact potency rates after radical prostatectomy. Further research will be needed, including parallel histologic evaluation and follow-up, to validate the findings of OCT imaging.
评估高分辨率光学相干断层扫描（OCT）在腹腔镜及机器人辅助根治性前列腺切除术（LRP）中识别神经血管束（NVBs）的可行性。
2005年11月至2006年3月期间，24例行经腹腹腔镜或机器人辅助根治性前列腺切除术的患者纳入本研究。一旦膀胱被分离且前列腺游离后，便部署Niris成像系统。对每位患者获取体内图像，以确定NVBs、脂肪组织、前列腺包膜及盆内筋膜的图像特征。前列腺切除后再次对NVB进行体内成像。从前列腺表面获取体外图像，以查找NVBs的存在与否，并与外科医生对神经保留充分性的评估进行关联。
从24例患者中，我们获得了300余张包括盆内筋膜、前列腺包膜、NVBs、脂肪、侧蒂及淋巴管在内的组织结构的OCT图像。发现这些图像与外科医生对所成像组织的印象独立相关。对4例患者进行了与平行组织学评估的初步比较，结果提示OCT有助于在LRP期间识别NVBs和前列腺包膜。
在我们使用Niris系统进行LRP的初步经验中，OCT能够对所有患者的NVB进行成像。这可提高神经保留期间的手术精度，并对根治性前列腺切除术后的性功能恢复率产生积极影响。需要进一步的研究，包括平行组织学评估和随访，以验证OCT成像的结果。
