Augmented-reality robot-assisted radical prostatectomy using hyper-accuracy three-dimensional reconstruction (HA3D™)...

Area of Science:

• Urology
• Surgical Technology
• Oncology

Background:

• Prostate cancer diagnosis and treatment rely on accurate imaging and surgical techniques.
• Robot-assisted radical prostatectomy (RARP) offers minimally invasive options for prostate cancer.
• Integrating advanced imaging with surgical platforms can potentially improve RARP outcomes.

Purpose of the Study:

• To evaluate the efficacy of hyper-accuracy 3D (HA3D™) reconstruction using multiparametric MRI (mpMRI) with augmented reality (AR) during RARP.
• To assess the accuracy of superimposed imaging for guiding surgical steps in RARP.
• To compare outcomes in patients with and without extracapsular extension (ECE).

Main Methods:

• Utilized HA3D™ reconstruction from mpMRI for creating 3D prostate models.
• Employed AR technology to overlay virtual models onto the surgical console's endoscopic view.
• Implemented standardized AR-guided steps, including metallic clip placement for lesion and ECE identification.
• Performed targeted biopsies and compared 3D virtual reconstructions with whole-mount specimens using 3D scanning.

Main Results:

• Final pathology confirmed index lesion location in all 30 patients (100%).
• Extracapsular extension (ECE) was confirmed in 79% of relevant cases (15/19).
• AR-guided biopsies accurately identified ECE in 73.3% of positive cases (11/15).
• Dimensional mismatch between virtual reconstruction and specimen was <3 mm in over 85% of the gland.

Conclusions:

• HA3D™ virtual reconstruction combined with AR-guided superimposed imaging enables effective RARP.
• This integrated approach has the potential to improve surgical outcomes by allowing patient-specific procedure tailoring.
• The technology demonstrated high accuracy in localizing prostate cancer lesions and assessing ECE during RARP.