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.

中文翻译：

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机器人辅助前列腺癌根治术中使用增强现实指导术中冰冻切片

背景

多参数磁共振成像（mpMRI）可以在机器人辅助根治性前列腺切除术（RARP）期间指导手术计划，术中冰冻切片（IFS）可以促进实时手术切缘评估。

客观的

通过在计划进行神经保留 RARP (NS-RARP) 的患者中使用增强现实三维 (AR-3D) 模型来评估针对索引病变的 IFS 新技术。

设计、设置和参与者

在 2019 年 3 月至 2019 年 7 月期间，连续 20 名前列腺癌患者在 AR-3D 模型（研究组）的帮助下接受了针对指标病变的 IFS 的 NS-RARP。对照组由 20 名患者组成，年龄、临床分期、前列腺成像报告和数据系统评分 v2、国际泌尿病理学会分级、前列腺体积、NS 方法和前列腺特异性抗原 1:1 匹配通过 mpMRI 的认知评估进行。

外科手术

在研究组中，将AR-3D模型叠加到手术区域以指导手术解剖。IFS 的组织取样是在 AR-3D 指导预测的索引病变区域进行的。

测量

采用卡方检验、Student t检验和 Mann-Whitney U检验分别比较两组之间的比例、均值和中位数。

结果和局限性

AR-3D 组的患者具有可比的术前特征，接受 NS 方法的患者被称为对照组（均p  ≥ 0.06）。总体而言，两组的手术切缘阳性率（PSM）具有可比性；参考 AR-3D 引导 IFS 至指标病变的患者（5%）指标病变水平的 PSM 显着低于对照组（20%；p  = 0.01）。

结论

用于 IFS 分析的 AR-3D 引导新技术可以减少指标病变水平的 PSM。

患者总结

机器人辅助根治性前列腺切除术术中冰冻切片分析的增强现实三维指导有助于实时评估手术切缘，并可能减少指标病变处的阳性手术切缘。