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The application of mixed reality navigation system in robot-assisted radical prostatectomy for high-risk prostate
Wangmin Liu1,2, Siyu Zhou1,2, Xueyang Yu3,4
1Department of Urology, The First Hospital of China Medical University, Shenyang, China.
Background:
This study aims to evaluate the efficacy and advantages of MR navigation system in robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer (PCa).
Methods:
We retrospectively studied 147 patients with high-risk PCa based on D'Amico risk criteria from July 2021 to November 2023. All patients chose MR-assisted RARP (MR-RARP) or standard RARP (S-RARP) after receiving comprehensive counseling on the benefits and risks of both procedures. After propensity score-matching, 57 patients were included in each group. Perioperative, functional and oncological outcomes were compared. Logistic and Cox regression models were used to identify predictors of positive surgical margin (PSM), biochemical recurrence (BCR), continence and potency recovery.
Results:
The MR-RARP group had higher nerve-sparing (NS) rates (78.9% vs 54.4%, P = 0.021) and lower PSM rates (10.5% vs 26.3%, P = 0.030). Continence recovery rates were higher in the MR-RARP group at catheter removal (40.4% vs 22.8%, P = 0.044), 1 month (61.4% vs 38.6%, P = 0.015) and 3 months (73.7% vs 47.4%, P = 0.004), with no significant differences at 6 months (82.5% vs 73.7%, P = 0.258) and 12 months (93.0% vs 87.7%, P = 0.341). Furthermore, the MR-RARP group demonstrated higher potency rates at 1 month (42.1% vs 21.1%, P = 0.016) and 3 months (57.9% vs 36.8%, P = 0.024), whereas outcomes were comparable at 6 months (66.7% vs 56.1%, P = 0.248) and 12 months (77.2% vs 66.7%, P = 0.211). With a median follow-up of 28 months, BCR-free survival showed no significant differences (P = 0.295). Multivariate analyses confirmed MR navigation as an independent predictor of PSM, continence, and potency recovery (all P < 0.05). Statistical power analysis indicated a power of 0.847.
Conclusions:
Real-time intraoperative MR navigation enhances surgical precision, facilitates NS techniques, and optimizes early continence and potency recovery without compromising oncological safety.
Insights
MR navigation in robot-assisted radical prostatectomy improves nerve-sparing rates and early functional recovery for high-risk prostate cancer patients. This technology enhances precision without compromising oncological outcomes.
Area of Science:
- Urology
- Surgical Oncology
- Medical Imaging
Background:
- Robot-assisted radical prostatectomy (RARP) is a standard treatment for prostate cancer (PCa).
- High-risk PCa presents unique surgical challenges.
- The efficacy of Magnetic Resonance (MR) navigation systems in RARP for high-risk PCa requires evaluation.
Purpose of the Study:
- To assess the effectiveness and benefits of using an MR navigation system during RARP for high-risk PCa.
- To compare outcomes between MR-assisted RARP (MR-RARP) and standard RARP (S-RARP).
Main Methods:
- Retrospective study of 147 high-risk PCa patients (July 2021-November 2023).
- Propensity score-matching created two groups: MR-RARP (57 patients) and S-RARP (57 patients).
- Comparison of perioperative, functional, and oncological outcomes using logistic and Cox regression models.
Main Results:
- MR-RARP showed significantly higher nerve-sparing (NS) rates (78.9% vs 54.4%) and lower positive surgical margin (PSM) rates (10.5% vs 26.3%).
- Earlier continence recovery was observed in the MR-RARP group at catheter removal, 1, and 3 months post-surgery.
- Higher potency recovery rates were noted in the MR-RARP group at 1 and 3 months, with comparable long-term results.
- No significant difference in biochemical recurrence (BCR)-free survival was found between groups after a median follow-up of 28 months.
Conclusions:
- Real-time intraoperative MR navigation enhances surgical precision in RARP.
- MR navigation facilitates nerve-sparing techniques, leading to improved early functional recovery (continence and potency).
- The use of MR navigation in RARP for high-risk PCa is safe and does not compromise oncological control.
