Category: Reconstruction: Malignant

MP14-10 - 3D Augmented-Reality Robot-Assisted Radical Prostatectomy: results of a phase II study

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : Nowadays, in prostate cancer surgical procedures, oncological and functional outcomes are equally important. The improvement of new technologies and minimally invasive surgery translated into a more tailored approach. Nevertheless, the standard preoperative imaging still remains the routine tool for surgical planning and intraoperative decision-making, requiring an intraoperative mental imagination. In this setting, the 3D rendering and the intraoperative surgical navigation allow to overcome the limitation of this «building in mind» process. Aim of this study is to present our preliminary experience with augmented reality robot-assisted radical prostatectomy (AR-RARP).


Methods : According to dedicated protocol, from June 2017 to March 2018 patients candidate to RARP were enrolled and underwent high resolution (1-mm slices) multiparametric Magnetic Resonance (mpMRI ). 3D reconstruction obtained was integrated in the robotic console to perform AR-RARP. According to the MRI-reconstruction staging, patients with cT2 PCa, underwent intrafascial nerve sparing (NS): a mark was placed at prostate capsule to indicate the underlying intraprostatic lesion; in case of cT3, standard NS AR-RARP was scheduled and AR-guided biopsies at the level of suspected extracapsular extension (ECE) were performed. Prostate specimens were scanned to assess the 3D model concordance.


Results : 25 patients underwent intrafascial NS technique (cT2) and 25 underwent standard NS + selective biopsy of suspected ECE (cT3). Final pathology confirmed clinical staging. Positive surgical margins rate was 27% overall and 4.2% in pT2. The location of marked intra-prostatic lesions were confirmed at final pathology. In suspected ECE, AR-guided selective biopsies confirmed the ECE location, with 20/25 (80%) positive biopsies for PCa. Prostate specimens were scanned finding a good overlap. The mismatch between 3D reconstruction and scanning ranged from 1 to 5 mm. In the 85% of the entire surface it was < 3 mm.


Conclusions : In our preliminary experience, AR-RARP is safe and effective. The exactitude of 3D reconstruction seemed to be promising. This technology has still limits: the virtual models are rigid and they need manually orientation. Future collaborations with bioengineers are mandatory to overcoming 

Matteo Manfredi

Urologist
Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Matteo Manfredi, MD, full time Urologist at the Division of Urology, San Luigi Hospital – Orbassano (Turin) - University of Turin (Chief: Prof. F. Porpiglia).
He is a member of the Piedmont and Aosta Valley Urological Association (AUP); Italian Society of Urology (SIU); European Association of Urology (EAU).
His scientific activity is documented by more than 100 scientific publications (full papers and abstracts). The main fields of interest are: urinary stone disease, uro-oncology, laparoscopy and robot-assisted surgery, magnetic resonance imaging of prostate. He won, within a collaboration group between Division of Urology - San Luigi Gonzaga Hospital – Orbassano, Torino and Department of Molecular Biotechnology - Torino (University of Turin), of the Investigator Grant 2013 of the AIRC (Italian Cancer Research Association) with the project entitled "Dual MRI-Optical imaging agents in prostatectomy", currently underway. He participated as a co-experimenter to more than 10 clinical studies approved by the Ethic Committee of San Luigi Gonzaga Hospital – Orbassano, Torino.
Overall (as of May 2018):
the number of works in extenso (http://www.ncbi.nlm.nih.gov/pubmed) is equal to 26
the number of citations (www.scopus.com) is equal to 301
the H index (www.scopus.com) is equal to 9

Francesco Porpiglia

Full Professor of Urology
Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Ivano Morra

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Turin, Piemonte, Italy

Daniele Amparore

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Diletta Garrou

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Giovanni Cattaneo

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Enrico Checcucci

Urology Resident
Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Personal statement: Urology Resident at the University of Turin, Italy
Education and training: Currently Foundation Doctor in Italy

Title of awarded qualifications:
- 12/02/2015: Licensed to practice Medicine In Italy and registration at the Turin General Medical Council (n )
- 24/10/2014: Graduation in Medicine at the University of Turin, Italy (votation: 108/110) - Master Thesis: “TOTAL ANATOMICAL RECONSTRUCTION DURING ROBOT-ASSISTED-RADICAL- PROSTATECTOMY (RARP): EARLY FUNCTIONAL OUTCOMES OF A NEW TECHNIQUE"; Printout dignity. Supervisor: Prof. Francesco Porpiglia
- 07/2008: High School Diploma (votation: 86/100)

Name and type of organization providing education and training:
- 2003-2008 Liceo Salesiano Valsalice, Turin- Italy
- 2008-2015 University of Turin, Italy
- 2013-2015 Internee at “San Luigi Gonzaga” Hospital, division of Urology, Orbassno-Turin, Italy. Director: Prof. F. Porpiglia
- 03/2014 – 06/2014 Elective student at Kings College of London; internship at Guy’s Hospital, division of Urology, under supervision of Professor P. Dasgupta

Angela Pecoraro

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Dario Peretti

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Alberto Piana

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
orbassano, Piemonte, Italy

Gabriele Volpi

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy

Marco Cossu

Department of Urology, AOU San Luigi Gonzaga Orbassano - Turin; University of Turin
Orbassano, Piemonte, Italy

Cristian Fiori

Department of Urology, AOU San Luigi Gonzaga Orbassano – Turin; University of Turin
Orbassano, Piemonte, Italy