MP37-17 INTRAOPERATIVE REGISTERED TRANSRECTAL ULTRASOUND GUIDANCE FOR ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: A 20 PATIENT STUDY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics - Benign & Malignant Disease1 Apr 2014MP37-17 INTRAOPERATIVE REGISTERED TRANSRECTAL ULTRASOUND GUIDANCE FOR ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: A 20 PATIENT STUDY Omid Mohareri, Joseph Ischia, Peter Black, Larry Goldenberg, Julio Lobo, Caitlin Schneider, and Septimiu Salcudean Omid MohareriOmid Mohareri More articles by this author , Joseph IschiaJoseph Ischia More articles by this author , Peter BlackPeter Black More articles by this author , Larry GoldenbergLarry Goldenberg More articles by this author , Julio LoboJulio Lobo More articles by this author , Caitlin SchneiderCaitlin Schneider More articles by this author , and Septimiu SalcudeanSeptimiu Salcudean More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1254AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This work demonstrates, for the first time, the clinical application of a robotic transrectal ultrasound (TRUS) system calibrated to the da Vinci surgical system, for real-time monitoring of the prostate and periprostatic anatomy from the surgeon’s console during robot-assisted laparoscopic radical prostatectomy (RALRP). METHODS Twenty patients (60.27±4.6 years of age; 33.16±11.78 cc prostate volume) with organ-confined prostate cancer undergoing RALRP at our institution agreed to participate in this CREB-approved (clinical research ethics board) study. Before docking the da Vinci system, our robotic TRUS system was attached to the foot of the operating table and a TRUS transducer was placed and adjusted to provide optimal transverse and sagittal images of the prostate and its surrounding structures. Furthermore, once the anterior surface of the prostate was visible to the surgeon, a registration technique was performed between the TRUS transducer and the da Vinci instrument, to enable the TRUS imaging plane to automatically track the tip of the da Vinci instrument. The mean duration of calibration procedure was 137.1 ± 29.59 sec. After the registration, movements of the instrument tip was constantly visible in the ultrasound image, showing the location of the tools relative to the target anatomy. RESULTS During each procedure, the TRUS robot was used to remotely control the rotation angle and insertion depth of the TRUS transducer and real-time TRUS images were relayed to the surgeon at the console using the TilePro feature of the da Vinci. No major complications occurred and the TRUS remained in place until the end of procedures. The TRUS imaging was found useful in the following stages: identifying urethra while passing the dorsal venous complex suture, defining the prostate-bladder interface during posterior and anterior bladder neck dissection, identifying the lateral edges of the seminal vesicles and their location with respect to the rectal wall, and identifying the prostate boundary at the apex. Automatic tool tracking was activated during all critical stages of the surgery to facilitate real-time TRUS navigation using the same instruments being used during the procedure. CONCLUSIONS We conclude that real-time TRUS imaging can be deployed and used easily during surgery, can be registered to the da Vinci surgical system instruments with high accuracy in a short time for remote control from the surgeon console, and it can provide the console surgeon with valuable anatomic information, aiming to improve procedure outcomes. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e398-e399 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Omid Mohareri More articles by this author Joseph Ischia More articles by this author Peter Black More articles by this author Larry Goldenberg More articles by this author Julio Lobo More articles by this author Caitlin Schneider More articles by this author Septimiu Salcudean More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...