The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-assisted Radical Prostatectomy.

Augmented Reality Frozen Sections Humans Male Margins of Excision Prostate Prostatectomy Prostatic Neoplasms / diagnostic imaging Robotic Surgical Procedures / adverse effects Robotics

Augmented reality Intraoperative frozen section Prostate cancer Robot-assisted radical prostatectomy Three-dimensional reconstruction

Journal

European urology

ISSN: 1873-7560

Titre abrégé: Eur Urol

Pays: Switzerland

ID NLM: 7512719

Informations de publication

Date de publication:
10 2021

Historique:

received: 17 03 2021

accepted: 24 06 2021

pubmed: 2 8 2021

medline: 11 3 2022

entrez: 1 8 2021

Statut: ppublish

Résumé

Multiparametric magnetic resonance imaging (mpMRI) can guide the surgical plan during robot-assisted radical prostatectomy (RARP), and intraoperative frozen section (IFS) can facilitate real-time surgical margin assessment. To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP). Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI. In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance. Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups. Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01). The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion. Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.

Sections du résumé

BACKGROUND

OBJECTIVE

To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP).

DESIGN, SETTING, AND PARTICIPANTS

Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI.

SURGICAL PROCEDURE

In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance.

MEASUREMENTS

Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups.

RESULTS AND LIMITATIONS

Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01).

CONCLUSIONS

The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion.

PATIENT SUMMARY

Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.

Identifiants

DOI: 10.1016/j.eururo.2021.06.020 PMID: 34332759

pubmed: 34332759

pii: S0302-2838(21)01861-3

doi: 10.1016/j.eururo.2021.06.020

pii:

doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

480-488

Commentaires et corrections

Type : CommentIn