1229 ROBOT-ASSISTED LAPAROSCOPIC INTRAOPERATIVE BRACHYTHERAPY: A PORCINE TRIAL

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics - Malignant Disease & Benign Disease I1 Apr 20121229 ROBOT-ASSISTED LAPAROSCOPIC INTRAOPERATIVE BRACHYTHERAPY: A PORCINE TRIAL Jennifer Yates, Dan Smith, Stephen Musialek, Ravi Munver, Ihor Sawczuk, Samay Jain, and Loren Godfrey Jennifer YatesJennifer Yates Hackensack, NJ More articles by this author , Dan SmithDan Smith Teaneck, NJ More articles by this author , Stephen MusialekStephen Musialek Hackensack, NJ More articles by this author , Ravi MunverRavi Munver Hackensack, NJ More articles by this author , Ihor SawczukIhor Sawczuk Hackensack, NJ More articles by this author , Samay JainSamay Jain Hackensack, NJ More articles by this author , and Loren GodfreyLoren Godfrey Hackensack, NJ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1519AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative brachytherapy using an electronic brachytherapy source is currently utilized for dermatologic and breast malignancies. Patients with advanced urologic disease are often treated with multimodal therapy, including surgical excision and postoperative radiotherapy. Delivery of intraoperative brachytherapy at the time of surgery is limited in part by the radiation source and a means of delivering the brachytherapy in a minimally-invasive fashion. The Xoft electronic brachytherapy device is portable and does not require operative room shielding. A minimally-invasive intraoperative radiotherapy (IORT) technique has been developed which utilizes the robotic platform, the Xoft electronic brachytherapy source, and minimally-invasive applicators. The feasibility of applying this system to a pelvic target in the porcine model was explored. METHODS In-vivo trials were conducted at the David Jurist Research Institute at Hackensack University Medical Center after obtaining IACUC Board approval. A DaVinci standard Robotic Surgical System was used to manipulate minimally-invasive brachytherapy applicators and Axxent electronic brachytherapy catheters (Xoft Inc., Sunnyvale, CA). A porcine pelvic target was identified that served as a surrogate for periprostatic tissue in the human patient. RESULTS Trocars were placed in a fashion similar to a prostatectomy template, with three robotic arms (8 mm trocars) and one 12 mm assistant trocar utilized. Two of the robotic arms were equipped with grasping instruments, and the third robotic arm was equipped with a forceps to manipulate the GafChromic paper. The Axxent electronic brachytherapy applicator was advanced through the 12 mm assistant trocar. While the minimally-invasive applicator was held in position with the robotic instruments, the brachytherapy catheter was used to deliver a prescribed brachytherapy treatment plan to the target. The minimally-invasive applicator could access the targeted site. Optimal stability of the applicator required two robotic arms. On average, five minutes were required to introduce, place, and stabilize the applicator. CONCLUSIONS The minimally invasive IORT system described above can be reproducibly deployed in-vivo. Additional in-vivo studies are needed to further characterize systematic and operator dependent variance and perform quantitative dose analysis. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e497 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Yates Hackensack, NJ More articles by this author Dan Smith Teaneck, NJ More articles by this author Stephen Musialek Hackensack, NJ More articles by this author Ravi Munver Hackensack, NJ More articles by this author Ihor Sawczuk Hackensack, NJ More articles by this author Samay Jain Hackensack, NJ More articles by this author Loren Godfrey Hackensack, NJ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...