V14-05 MRI FUSION GUIDED PROSTATE PARTIAL GLAND CRYOABLATION AIDED BY A VIRTUAL 3D MODELING: A STEP BY STEP ILLUSTRATION

Abstract

You have accessJournal of UrologyProstate Cancer (V14)1 Apr 2020V14-05 MRI FUSION GUIDED PROSTATE PARTIAL GLAND CRYOABLATION AIDED BY A VIRTUAL 3D MODELING: A STEP BY STEP ILLUSTRATION Ezequiel Becher*, Nicole Wake, Zachary Tano, Nermarie Velazquez, Herbert Lepor, and James Wysock Ezequiel Becher*Ezequiel Becher* More articles by this author , Nicole WakeNicole Wake More articles by this author , Zachary TanoZachary Tano More articles by this author , Nermarie VelazquezNermarie Velazquez More articles by this author , Herbert LeporHerbert Lepor More articles by this author , and James WysockJames Wysock More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000982.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe our technique for prostate partial gland cryoablation (PGCy) aided by a virtual 3D model and with magnetic resonance imaging (MRI)- ultrasound (US) fusion guidance. METHODS: Preoperatively, multiparametric prostate MRI imaging is used to develop a 3D virtual prostate model defining tumor location and planned treatment margin as well as critical structures such as the urethra, neurovascular bundle and rectum. This model also allows pre-treatment simulation using 3D virtual cryoprobes. Planning for number of treatment probes and probe configuration/location are simulated using this model to ensure confluent treatment volume. The cryoablation procedure is performed under general anesthesia with the patient in dorsal lithotomy position. A biplanar transrectal ultrasound probe is used to visualize the prostate. The Navigo® transperineal MRI-US fusion system creates 3D ultrasound segmentation and performs MRI registration prior to cryoprobe placement. A 1 cm tumor margin is employed. Combining the fusion image guidance and 3D virtual planning, cryoprobe and thermocouple placement planning is performed. After placement of a urethral warming catheter, two freeze-thaw cycles are performed. Treatment temperatures and US monitoring of ice development are performed in real-time. The procedure is completed after adequate treatment volume and a target freeze temperature has been achieved. An additional third freeze-thaw cycle may be performed on a case-by-case basis. RESULTS: This case illustrates PGCy using 3D pre-ablation modeling. The pretreatment model based upon mpMRI and assuming a 1 cm margin predicted use of 3 cryoprobes to achieve confluent treatment volume. The use of MRI-US fusion and execution of the 3D modeling is demonstrated. PGCy was safely done with 2 freeze / thaw cycles. CONCLUSIONS: Our virtual 3D model and MRI fusion guidance allowed us to plan for a more accurate and oncologically safe PGCy. This video also serves to show our technique to approaching PGCy. Source of Funding: Department of Urology, NYU Langone Health. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1307-e1307 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ezequiel Becher* More articles by this author Nicole Wake More articles by this author Zachary Tano More articles by this author Nermarie Velazquez More articles by this author Herbert Lepor More articles by this author James Wysock More articles by this author Expand All Advertisement PDF downloadLoading ...