V2155 INTRA-OPERATIVE ULTRASONOGRAPHY USING MINIATURE DROP-TYPE ULTRASOUND PROBE MANIPULATED BY SURGEON DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyRobotics, Single Port Surgery, LESS, NOTES1 Apr 2013V2155 INTRA-OPERATIVE ULTRASONOGRAPHY USING MINIATURE DROP-TYPE ULTRASOUND PROBE MANIPULATED BY SURGEON DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY Sunao Shoji, Monish Aron, Andre Luis De Castro Abreu, Scott Leslie, Alvin Goh, Andre Berger, Toyoaki Uchida, Mihir Desai, Inderbir Gill, and Osamu Ukimura Sunao ShojiSunao Shoji Los Angeles, CA More articles by this author , Monish AronMonish Aron Los Angeles, CA More articles by this author , Andre Luis De Castro AbreuAndre Luis De Castro Abreu Los Angeles, CA More articles by this author , Scott LeslieScott Leslie Los Angeles, CA More articles by this author , Alvin GohAlvin Goh Los Angeles, CA More articles by this author , Andre BergerAndre Berger Los Angeles, CA More articles by this author , Toyoaki UchidaToyoaki Uchida Hachioji, Japan More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , Inderbir GillInderbir Gill Los Angeles, CA More articles by this author , and Osamu UkimuraOsamu Ukimura Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2064AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Image navigation beyond the endoscopic view potentially improves oncological and functional outcomes. We evaluate the utility of drop-type miniature ultrasound (US) probe (Hitachi Aloka Medical Ltd. CT, USA) for real-time navigation during robot-assisted radical prostatectomy (RARP). METHODS Seventeen patients with age (64 years), clinical stage T1c/T2a/T2b=6/6/5, PSA (7.5 ng/ml), and biopsy Gleason score of 3+3 (n=7) 3+4 (n=3), 4+3 (n=3), 4+4 (n=3) were enrolled. 41% (6/17) had high risk cancer with Gleason 4+3 or higher in biopsy. Mini probe was designed as gdrop-type h to be manipulated by robotic arm with a flexible cord through the laparoscopic port. The size was 9 ∼16 ∼6 mm in diameter, and multi-frequency from 5 to 13 MHz was available, to allow various penetration of US to visualize any tissues with various distances from the probe. Intra-operative US data was transferred to the da Vinci console to provide the real-time US image shown directly to surgeon in parallel to the surgical view in the Tile-pro display. RESULTS The median time to use intra-operative US was only 3 minutes in total. Based on the surgeonüfs rating for the utility of the probe, its utilities were excellent regarding 3 aspects as following: (a) visualization of bladder neck to facilitate preservation of bladder neck as small as possible, (b) intra-operative localization of biopsy-proven hypo-echoic lesion (HEL), and (c) identification of releasing line of the neuro-vascular bundle (NVB) adjacent to the posterior-lateral surface of the prostate. Combined consideration of (b) and (c) helped intra-operative decision making to perform wider dissection for partial or complete nerve sparing in order to achieve negative surgical margin. Prostatectomy specimens revealed Gleason score 6/3+4/4+3/8/9 cancer in N=3/8/1/3/2, respectively, and pathological stage pT2a/pT2c/pT3a/pT3b in N=4/7/2/4, respectively. Although over 40% men of this series had high risk and/or extra-prostatic disease, negative surgical margins were achieved in 94% (16/17). Intraoperative complication was none. CONCLUSIONS Intra-operative navigation using novel mini US probe is feasible and safe. To visualize the critical anatomy beyond the endoscopic view such as cancer location and proximity of NVB in console display provided a new opportunity for surgical navigation controlled by robotic surgeon. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e882-e883 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunao Shoji Los Angeles, CA More articles by this author Monish Aron Los Angeles, CA More articles by this author Andre Luis De Castro Abreu Los Angeles, CA More articles by this author Scott Leslie Los Angeles, CA More articles by this author Alvin Goh Los Angeles, CA More articles by this author Andre Berger Los Angeles, CA More articles by this author Toyoaki Uchida Hachioji, Japan More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Osamu Ukimura Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...