Artificial Intelligence 3D Augmented Reality-guided Robotic Prostatectomy Versus Cognitive MRI Intervention: Results...

Area of Science:

• Urology
• Surgical Technology
• Oncology

Background:

• Robot-assisted radical prostatectomy (RARP) is a key treatment for prostate cancer.
• Enhancements in surgical guidance are crucial for improving outcomes.
• Three-dimensional (3D) augmented reality (AR) and artificial intelligence (AI) offer new possibilities for intraoperative guidance.

Purpose of the Study:

• To evaluate if 3D-AI-AR guidance reduces positive surgical margins (PSMs) during RARP compared to standard 2D MRI guidance.
• To assess the impact of 3D-AI-AR guidance on oncological and functional outcomes.

Main Methods:

• A prospective, multicenter randomized controlled trial involving 133 patients with specific MRI findings.
• Patients were randomized to either 2D MRI-guided (n=84) or 3D-AI-AR-guided RARP (n=49).
• Intraoperative biopsies of the neurovascular bundle (NVB) were performed, guided by cognitive MRI or AR.

Main Results:

• While PSMs on the prostate surface were similar, 3D-AI-AR guided biopsies showed a significantly higher positivity rate (52% vs 13%), improving margin control.
• The 3D-AI-AR group had a lower overall PSM rate (22% vs 39%) and required less postoperative radiotherapy (18% vs 35%).
• Higher continence rates were observed in the 3D-AI-AR group at 12 months (91% vs 71%).

Conclusions:

• 3D-AI-AR guided biopsy during nerve-sparing RARP improves tumor identification and margin control.
• This technology shows promise for enhancing surgical precision and patient outcomes in RARP.
• Further long-term follow-up is needed to fully assess oncological and functional results.