Lorenzo Bianchi, Francesco Chessa, Andrea Angiolini, Laura Cercenelli, Simone Lodi, Barbara Bortolani, Enrico Molinaroli, Carlo Casablanca, Matteo Droghetti, Caterina Gaudiano, Angelo Mottaran, Angelo Porreca, Rita Golfieri, Daniele Romagnoli, Francesca Giunchi, Michelangelo Fiorentino, Pietro Piazza, Stefano Puliatti, Stefano Diciotti, Emanuela Marcelli, Alexandre Mottrie, Riccardo Schiavina
- PMID: 34332759
- DOI: 10.1016/j.eururo.2021.06.020
Abstract
Background: Multiparametric magnetic resonance imaging (mpMRI) can guide the surgical plan during robot-assisted radical prostatectomy (RARP), and intraoperative frozen section (IFS) can facilitate real-time surgical margin assessment.
Objective: To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP).
Design, setting, and participants: Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI.
Surgical procedure: In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance.
Measurements: Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups.
Results and limitations: Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01).
Conclusions: The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion.
Patient summary: Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.
Keywords: Augmented reality; Intraoperative frozen section; Prostate cancer; Robot-assisted radical prostatectomy; Three-dimensional reconstruction.
Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.
