INTRODUCTION AND OBJECTIVE:
Planning complex operations such as robotic-assisted laparoscopic radical prostatectomy (RALP) requires surgeons to review two-dimensional Magnetic Resonance Imaging (MRI) images to understand three-dimensional (3D) anatomy. We examined the use of virtual 3D models for planning RALP to determine the effect on the trifecta of cancer control, continence, and erectile function.
Patients undergoing RALP performed by fifteen surgeons at six hospitals were enrolled in a randomized, single-blind clinical trial. Patients were assigned either to a control group undergoing preoperative planning with MRI, or to an intervention group where MRI was supplemented with a 3D model. The model was viewed on the surgeon’s mobile phone, in virtual reality using a headset, or on the surgical console using Tile Pro. Postoperative trifecta outcomes were 6-month continence, erectile function, and PSA.
Ninety-two patients were analyzed with no significant difference in preoperative characteristics except race (Table 1). After controlling for significant covariates, using a multivariable linear model, there were trends towards lower positive margin rates (25% vs 33%), better sexual function (43% vs 36% erectile fullness), and better urinary continence (0.9 vs 1.4 pads/day) in the intervention group compared to the control group, and no significant difference in nerve sparing and bladder neck sparing (Table 2). Detectable PSA was significantly lower in the intervention group (31% vs 9%, p=0.35) (Table 2). Comparing cases in the intervention group in which the surgeon changed operative plan based on the model (32%) to the control group, there was a strong trend towards increased bilateral nerve sparing (78% vs 92%), and a significant difference in postoperative detectable PSA (31% vs 0%, p=0.038) (data not shown).
Use of a virtual 3D model when performing RALP improves oncologic outcomes while maintaining functional outcomes.
Source of Funding:
Urology Care Foundation Research Scholar Award (Shirk)