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Updated: Jun 6, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
3D-printed model for resection of positive surgical margins in robot-assisted prostatectomy
Christian Engesser1, Philipp Brantner2,3, Brigitta Gahl4
1Department of Urology, University Hospital Basel, Basel, Switzerland.
Objectives:
To improve precision of secondary resection (SR) after positive surgical margin (PSM) detection by frozen section (FS) during nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) by employing a personalised three-dimensional (3D)-printed prostate model derived from pelvic magnetic resonance imaging (MRI). This model was used to mark positive surgical margins (PSM) and guide intraoperative SR during NS-RARP.
Patients And Methods:
Prospective multicentre cohort study with 100 patients undergoing NS-RARP between September 2018 and August 2021. Primary and secondary endpoints were the conversion rate of FS-identified PSM to a tumour-free margin and functional/oncological parameters within a 12-month follow-up, respectively.
Results:
A PSM was identified in 23% of cases during FS, with a conversion to negative surgical margins (NSM) in 83% (19/23 cases) by model-guided SR. The tumour detection rate in SR specimens was 39% (nine of 23 cases). Among the 19 patients with converted margins, 18 (95%) achieved undetectable prostate-specific antigen levels 2 months postoperatively, with six (32%) having subsequent biochemical recurrence within 12 months. prostate-specific-membrane-antigen positron emission tomography computed tomography found one local recurrence, and five cases of metastatic disease. In converted patients, the baseline median five-item version of the International Index of Erectile Function score decreased by 16% after 1 year, with no significant difference compared to patients with primarily NSM. Limitations include the absence of a control group, the potential for false-negative FS results and limited accuracy of MRI.
Conclusion:
The integration of 3D-printed prostate models into NS-RARP has the potential to positively impact surgical outcomes by improving the precision of SR and optimising pathosurgical communication.
Insights
Personalized 3D-printed prostate models improved secondary resection precision after positive surgical margins during nerve-sparing robot-assisted radical prostatectomy. This approach enhanced tumor-free margins and maintained functional outcomes.
Area of Science:
- Urology
- Surgical Oncology
- Medical Imaging
Background:
- Positive surgical margins (PSM) in nerve-sparing robot-assisted radical prostatectomy (NS-RARP) can lead to recurrence.
- Accurate identification and management of PSM are crucial for oncological control.
Purpose of the Study:
- To enhance the precision of secondary resection (SR) for PSM during NS-RARP.
- To utilize personalized 3D-printed prostate models derived from MRI to guide intraoperative SR.
Main Methods:
- Prospective multicenter cohort study of 100 patients undergoing NS-RARP.
- 3D-printed models created from pelvic MRI were used to mark PSMs and guide SR.
- Evaluated conversion rate of PSM to negative surgical margins (NSM) and functional/oncological outcomes over 12 months.
Main Results:
- Frozen section identified PSM in 23% of cases, with 83% converted to NSM using model-guided SR.
- Tumor was detected in 39% of SR specimens.
- 18 of 19 patients with converted margins achieved undetectable PSA at 2 months, with 32% experiencing biochemical recurrence within 12 months.
- Erectile function showed no significant difference compared to patients with primary NSM.
Conclusions:
- Integration of 3D-printed prostate models can improve SR precision in NS-RARP.
- This technology has the potential to optimize surgical outcomes and pathosurgical communication.
