Porpiglia Francesco, Checcucci Enrico, Amparore Daniele, Manfredi Matteo, Massa Federica, Piazzolla Pietro, Manfrin Diego, Piana Alberto, Tota Daniele, Bollito Enrico, Fiori Cristian
Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Orbassano, Turin, Italy.
Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Orbassano, Turin, Italy.
Eur Urol. 2019 Oct;76(4):505-514. doi: 10.1016/j.eururo.2019.03.037. Epub 2019 Apr 9.
In prostate cancer (PCa) surgical procedures, in order to maximize potency recovery, a nerve-sparing (NS) procedure is preferred. However, cancer abutting or focally extending beyond the prostate capsule increases the risk of a positive surgical margin.
To evaluate the accuracy of our new three-dimensional (3D) elastic augmented-reality (AR) system in identifying capsular involvement (CI) location of PCa during the NS phase of robot-assisted radical prostatectomy (RARP). Secondarily, the accuracy of this technology was compared with two-dimensional (2D)-based cognitive procedures.
DESIGN, SETTING, AND PARTICIPANTS: A prospective study, enrolling 40 patients with PCa undergoing RARP at our center, from May to October 2018.
Patients underwent 3D AR RARP or, in case of unavailability of this technology, 2D cognitive RARP. In all patients, total anatomical reconstruction was used.
Clinical data were collected. In order to compare the two groups, nonparametric Mann-Whitney and chi-square tests were performed. A metallic clip was placed at the level of suspicious CI on the basis of images given by the 3D AR or magnetic resonance imaging (MRI) report. The pathological analysis evaluated the presence of tumor at the level of the clip.
Twenty patients were enrolled in each group. Focusing on the 3D AR group at macroscopic evaluation, the metallic clip was placed at the tumor and capsular bulging in all cases. At microscopic assessment, cancer presence was confirmed in the suspicious area in 95.4% of the cases. Moreover, CI was correctly identified in 100.0% of the cases, thanks to the 3D image overlap. These results were compared with the 2D MRI cognitive group, showing, at microscopic analysis, statistically significant superiority of the 3D AR group in CI detection during the NS phase (100% vs 47.0%; p<0.05). The main limitation of this technique is that the segmentation and overlapping of the images are performed manually.
Our findings suggest that, with the introduction of the elastic 3D virtual models, prostate deformation is correctly simulated during surgery and lesion location is correctly identified, even in dynamic reality with a subsequent potential reduction of positive surgical margin rate and, in the meantime, maximization of functional outcomes.
On the basis of our findings, the three-dimensional elastic augmented-reality technology seems to help the surgeon in lesion location identification even in a dynamic phase of the intervention, optimizing the oncological outcomes.
在前列腺癌（PCa）手术中，为了最大程度地恢复性功能，保留神经（NS）手术是首选。然而，癌灶紧邻或局部延伸超出前列腺包膜会增加手术切缘阳性的风险。
评估我们新的三维（3D）弹性增强现实（AR）系统在机器人辅助根治性前列腺切除术（RARP）的NS阶段识别PCa包膜侵犯（CI）位置的准确性。其次，将该技术的准确性与基于二维（2D）的认知程序进行比较。
设计、场所和参与者：一项前瞻性研究，纳入了2018年5月至10月在我们中心接受RARP的40例PCa患者。
患者接受3D AR RARP，或者在该技术不可用时接受2D认知RARP。所有患者均采用全解剖重建。
收集临床数据。为了比较两组，进行了非参数曼-惠特尼检验和卡方检验。根据3D AR或磁共振成像（MRI）报告提供的图像，在可疑CI水平放置一个金属夹。病理分析评估夹子水平处是否存在肿瘤。
每组纳入20例患者。在宏观评估中关注3D AR组，在所有病例中金属夹均放置在肿瘤和包膜膨出处。在微观评估中，95.4%的病例在可疑区域证实存在癌症。此外，由于3D图像重叠，100.0%的病例正确识别了CI。将这些结果与2D MRI认知组进行比较，在微观分析中显示，3D AR组在NS阶段CI检测方面具有统计学上的显著优势（100%对47.0%；p<0.05）。该技术的主要局限性在于图像的分割和重叠是手动进行的。
我们的研究结果表明，随着弹性3D虚拟模型的引入，手术过程中能够正确模拟前列腺变形并正确识别病变位置，即使在动态情况下，随后可能降低手术切缘阳性率，同时使功能结果最大化。
根据我们的研究结果，三维弹性增强现实技术似乎有助于外科医生在干预的动态阶段识别病变位置，优化肿瘤学结果。
