Abstract
.Surgical excision of the whole prostate through a radical prostatectomy procedure is part of the standard of care for prostate cancer. Positive surgical margins (cancer cells having spread into surrounding nonresected tissue) occur in as many as 1 in 5 cases and strongly correlate with disease recurrence and the requirement of adjuvant treatment. Margin assessment is currently only performed by pathologists hours to days following surgery and the integration of a real-time surgical readout would benefit current prostatectomy procedures. Raman spectroscopy is a promising technology to assess surgical margins: its in vivo use during radical prostatectomy could help insure the extent of resected prostate and cancerous tissue is maximized. We thus present the design and development of a dual excitation Raman spectroscopy system (680- and 785-nm excitations) integrated to the robotic da Vinci surgical platform for in vivo use. Following validation in phantoms, spectroscopic data from 20 whole human prostates immediately following radical prostatectomy are obtained using the system. With this dataset, we are able to distinguish prostate from extra prostatic tissue with an accuracy, sensitivity, and specificity of 91%, 90.5%, and 96%, respectively. Finally, the integrated Raman spectroscopy system is used to collect preliminary spectroscopic data at the surgical margin in vivo in four patients.
Highlights
Prostate cancer is the second most frequently diagnosed cancer worldwide.[1]
The thickest fiber in the probe has a minimum bend radius of ∼1.5 mm. Bending this extreme is avoidable with this design for two reasons: slack provided by the 1.5 m of fiber allows for larger bend radii and the drop-in design allows for the probe to be picked up at different instrument angles
Limiting the risk of disease recurrence for patients undergoing radical prostatectomy can be achieved by ensuring that the prostate organ is completely removed and that the disease has not spread beyond the prostatic capsule
Summary
Prostate cancer is the second most frequently diagnosed cancer worldwide.[1]. In the United States, in 2015, there were an estimated 220,800 new cases and 27,540 deaths, namely ∼9% of all cancer-related deaths.[2]. Recent large surveys of the SEER and National Cancer databases show an increase in the use of radical prostatectomy to 40% to 55% of cases, while rates of radiotherapy-based treatment have decreased for medium- and high risk patients over the past decade.[3,4] Radical prostatectomy procedures can be performed either using open or minimally invasive techniques (classic laparoscopy or robotic-assisted surgical methods). Invasive techniques have comparable clinical outcomes; robotic-assisted prostatectomy procedures lead to shorter hospital stays, less blood loss, and reduced complication rates.[5] robotic surgery provides magnified, stereoscopic, high-definition visualization, a wide range of motion (seven degrees of freedom), elimination of tremor, and surgeon comfort at a seated console.[6] Adoption of the robotic surgery systems has been rising over the last decade: a retrospective study of >500; 000 prostatectomies performed in the U.S found adoption rates for robotic surgery leaping from 0.7% in 2003 to 42% in 2010.7
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