Three-dimensional surgical navigation model with TilePro display during robot-assisted radical prostatectomy

J Endourol. 2014 Jun;28(6):625-30. doi: 10.1089/end.2013.0749. Epub 2014 May 8.

Abstract

Abstract To facilitate robotic nerve-sparing radical prostatectomy, we developed a novel three-dimensional (3D) surgical navigation model that is displayed on the TilePro function of the da Vinci® surgeon console. Based on 3D transrectal ultrasonography (TRUS)-guided prostate biopsies, we reconstructed a 3D model of the TRUS-visible, histologically confirmed "index" cancer lesion in 10 consecutive patients. Five key anatomic structures (prostate, image-visible biopsy-proven "index" cancer lesion, neurovascular bundles, urethra, and recorded biopsy trajectories) were image-fused and displayed onto the TilePro function of the robotic console. The 3D model facilitated careful surgical dissection in the vicinity of the biopsy-proven index lesion. Geographic location of the index lesion on the final histology report correlated with the software-created 3D model. Negative surgical margins were achieved in 90%, except for one case with extensive extra-prostate extension. At postoperative 3 months, prostate-specific antigen levels were undetectable (<0.03 ng/mL) in all cases. The initial experience of the navigation model is presented.

MeSH terms

  • Aged
  • Biopsy
  • Humans
  • Male
  • Medical Illustration
  • Middle Aged
  • Models, Anatomic
  • Neoplasm Grading
  • Organ Sparing Treatments / methods*
  • Prostate-Specific Antigen / blood
  • Prostatectomy / methods*
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / surgery*
  • Robotics / methods*
  • Surgery, Computer-Assisted / methods*
  • Urethra / surgery

Substances

  • Prostate-Specific Antigen