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Minerva Urologica e Nefrologica 2018 April;70(2):226-9

DOI: 10.23736/S0393-2249.18.03143-0


lingua: Inglese

Augmented reality during robot-assisted radical prostatectomy: expert robotic surgeons’ on-the-spot insights after live surgery

Francesco PORPIGLIA 1 , Riccardo BERTOLO 1, Daniele AMPARORE 1, Enrico CHECCUCCI 1, Walter ARTIBANI 2, Prokar DASGUPTA 3, Francesco MONTORSI 4, Ashutosh TEWARI 5, Cristian FIORI 1, on behalf of ESUT

1 Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; 2 Department of Urology, G.B. Rossi Polyclinic, University of Verona, Verona, Italy; 3 Department of Urology, King’s College London, Guy’s Hospital, London, UK; 4 Department of Urology, Vita Salute San Raffaele University, Milan, Italy; 5 Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA


3D reconstruction of the standard two-dimension cross-sectional imaging has known increasing diffusion. It may represent one of the key points for a tailored treatment planning. Along these lines, we used a novel software for augmented-reality robot-assisted radical prostatectomy (AR-RARP) at our Institution. 3D virtual models of the prostate and the prostate cancer were reconstructed from high resolution (1-mm slices) multi-parametric Magnetic Resonance Imaging (mp-MRI) by M3dics (Turin, Italy). The innovation in the study is represented by the software-based integration of the virtual model inside the Da Vinci (Intuitive, Sunnyvale, CA, USA) robotic console during robotic prostatectomy. In January 2018, the above-described AR-RARP technique has been used during the live surgery sessions of the 6th Techno-Urology Meeting held at San Luigi Gonzaga Hospital (Orbassano, Turin, Italy). During this meeting, 6 experienced robotic surgeons (who have already performed more than 1000 RARP) used the software during nerve-sparing prostatectomy. The use of the technology was standardized to four key steps during the procedure: 1) bladder neck dissection; 2) nerve-sparing technique; 3) apex dissection; and 4) tailoring of eventual selective biopsies of prostatic lodge after prostatectomy). A Face Validity questionnaire was purpose-built aimed to collect the expert surgeons’ insights about the eventual help of the technology in guiding the surgeon during the above-described AR-RARP steps. It was administered at the end of the surgeries to the respective surgeons. The questionnaire was made of open-ended questions of ordinal ten-point rating Likert Scale (where 1 corresponded to a strongly negative opinion and 10 to a strongly positive opinion). The median value of Likert scale from the evaluation of each of the aforementioned steps of AR-RARP was 9, (IQR 9-10). These findings are a confirmation of the increasing interest for a new-generation of image-guided surgery. Particularly, AR-RARP seems to be a step in the direction of “precision” surgery.

KEY WORDS: Robotic surgical procedures - Prostatectomy - Computed-assisted surgery

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