Porpiglia Francesco, Fiori Cristian, Checcucci Enrico, Amparore Daniele, Bertolo Riccardo
Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
Urology. 2018 May;115:184. doi: 10.1016/j.urology.2018.01.028. Epub 2018 Mar 13.
To present our preliminary experience with augmented reality robot-assisted radical prostatectomy (AR-RARP).
From June to August 2017, patients candidate to RARP were enrolled and underwent high-resolution multi-parametric magnetic resonance imaging (1-mm slices) according to dedicated protocol. The obtained three-dimensional (3D) reconstruction was integrated in the robotic console to perform AR-RARP. According to the staging at magnetic resonance imaging or reconstruction, in case of cT2 prostate cancer, intrafascial nerve sparing (NS) was performed: a mark was placed on the prostate capsule to indicate the virtual underlying intraprostatic lesion; in case of cT3, standard NS AR-RARP was scheduled with AR-guided biopsy at the level of suspected extracapsular extension (ECE). Prostate specimens were scanned to assess the 3D model concordance.
Sixteen patients underwent intrafascial NS technique (cT2), whereas 14 underwent standard NS+ selective biopsy of suspected ECE (cT3). Final pathology confirmed clinical staging. Positive surgical margins' rate was 30% (no positive surgical margins in pT2). In patients whose intraprostatic lesions were marked, final pathology confirmed lesion location. In patients with suspected ECE, AR-guided selective biopsies confirmed the ECE location, with 11 of 14 biopsies (78%) positive for prostate cancer. Prostate specimens were scanned with finding of a good overlap. The mismatch between 3D reconstruction and scanning ranged from 1 to 5 mm. In 85% of the entire surface, the mismatch was <3 mm.
In our preliminary experience, AR-RARP seems to be safe and effective. The accuracy of 3D reconstruction seemed to be promising. This technology has still limitations: the virtual models are manually oriented and rigid. Future collaborations with bioengineers will allow overcoming these limitations.
介绍我们在增强现实机器人辅助根治性前列腺切除术（AR-RARP）方面的初步经验。
2017年6月至8月，招募符合RARP条件的患者，并根据专门方案进行高分辨率多参数磁共振成像（1毫米层厚）。将获得的三维（3D）重建图像整合到机器人控制台中以进行AR-RARP。根据磁共振成像或重建的分期，对于cT2期前列腺癌患者，进行筋膜内神经保留（NS）：在前列腺包膜上做标记以指示虚拟的前列腺内病变；对于cT3期患者，安排标准NS AR-RARP，并在疑似包膜外侵犯（ECE）水平进行AR引导下活检。对前列腺标本进行扫描以评估3D模型的一致性。
16例患者接受了筋膜内NS技术（cT2），而14例接受了标准NS + 疑似ECE的选择性活检（cT3）。最终病理证实了临床分期。手术切缘阳性率为30%（pT2期无手术切缘阳性）。在前列腺内病变做了标记的患者中，最终病理证实了病变位置。在疑似ECE的患者中，AR引导下的选择性活检证实了ECE的位置，14例活检中有11例（78%）前列腺癌阳性。对前列腺标本进行扫描发现重叠良好。3D重建与扫描之间的不匹配范围为1至5毫米。在整个表面的85%中，不匹配小于3毫米。
根据我们的初步经验，AR-RARP似乎是安全有效的。3D重建的准确性似乎很有前景。这项技术仍有局限性：虚拟模型是手动定向且刚性的。未来与生物工程师的合作将有助于克服这些局限性。
