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You have accessJournal of UrologyProstate Oncology/Penile & Testis Oncology/Misc. Oncology II (V12)1 May 2024V12-02 HOW TO MAXIMIZE ROBOTIC RADICAL PROSTATECTOMY OUTCOMES: SURGICAL AND NEW GENERATION IMAGING TIPS AND TRICKS Federico Piramide, Daniele Amparore, Enrico Checcucci, Sabrina T. De Cillis, Alberto Piana, Gabriele Volpi, Michele Sica, Paolo Verri, Mariano Burgio, Juliette Meziere, Giovanni Busacca, Edoardo Cisero, Luca Marsero, Alberto Quarà, Marco Colombo, Martina Mandaletti, Valentina Garzena, Bianca S. Ribolzi, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Federico PiramideFederico Piramide , Daniele AmparoreDaniele Amparore , Enrico CheccucciEnrico Checcucci , Sabrina T. De CillisSabrina T. De Cillis , Alberto PianaAlberto Piana , Gabriele VolpiGabriele Volpi , Michele SicaMichele Sica , Paolo VerriPaolo Verri , Mariano BurgioMariano Burgio , Juliette MeziereJuliette Meziere , Giovanni BusaccaGiovanni Busacca , Edoardo CiseroEdoardo Cisero , Luca MarseroLuca Marsero , Alberto QuaràAlberto Quarà , Marco ColomboMarco Colombo , Martina MandalettiMartina Mandaletti , Valentina GarzenaValentina Garzena , Bianca S. RibolziBianca S. Ribolzi , Matteo ManfrediMatteo Manfredi , Cristian FioriCristian Fiori , and Francesco PorpigliaFrancesco Porpiglia View All Author Informationhttps://doi.org/10.1097/01.JU.0001009480.90141.21.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the last decades, radical prostatectomy (RP) has undergone significant technical and technological changes to achieve complete cancer control while preserving functional outcomes. Their common idea is that the respect of anatomical structures is of paramount importance, especially for early urinary continence. Furthermore, new generation imaging, such as 3D virtual models (3DVMs), have been developed to assist surgeons during the different phases of RP. In this study we present surgical and 3DVMs tips and tricks and how to apply them to improve robot-assisted RP (RARP) outcomes. METHODS: 6 different key surgical steps have been studied and showed in this study: Endopelvic fascia preservation, bladder neck sparing, clipless Nerve sparing (NS) technique, preservation of apical surrounding structures, apical dissection and total anatomical reconstruction (combination of posterior and anterior reconstruction). 2 applications for 3DVMs were described: 1) intraoperative cognitive navigation, where thanks to detailed study of vascular anatomy, the 3DVMs can assist surgeons during the neurovascular bundle (NVB) dissection and 2) 3D guided NVB selective biopsy. Here thanks to the implementation of augmented reality (AR) technology with artificial intelligence (AI), the 3DVMS were automatically overlapped to the real anatomy at the end of the extirpative phase. Then, a selective excisional biopsy was taken on the NVB as indicated by 3D AR images. From 04/2023 to 09/2023, 130 patients with localized prostate cancer underwent RARP following all these surgical tips. Between them, 34 patients with suspected extracapsular extension (ECE) at MRI underwent 3DVMs reconstruction and received selective NVB biopsy intraoperatively. Perioperative and pathological variables were analysed. Continence (defined as no pad) and erectile function were evaluated at catheter removal, 1 and 3 months after. RESULTS: 73.8% and 26.2% of the patients were classified as cT2 and cT3 at MRI. Mean operating time was 110 minutes. The overall and Clavien >2 complications rate were 15.4% and 3.1%. The mean catheterization and hospitalization time were 4 and 5 days, respectively. 65.4% and 34.6% of patients were pT2 and pT3. Overall, 26% of patients had PSM and only 12% in the pT2 subgroup. Continence rate after CV removal and at 1st and 3rd postoperative month were 61%, 84% and 88%, respectively. 33% and 54% of patients had good erectile function at 1st and 3rd postoperative month. 3DVMs selective NVB biopsy was positive in 87.5% of patients with pT3 disease with only 1 (2.9%) patient had PSM on NVB biopsy at final pathological exam. CONCLUSIONS: The preservation of anatomical structures during RARP allows to maximize both oncological and functional outcomes. The implementation of AR with AI can improve the outcomes of this procedure, allowing surgeons to preserve the maximum amount of NVB without increasing the risk of PSM. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e994 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Federico Piramide More articles by this author Daniele Amparore More articles by this author Enrico Checcucci More articles by this author Sabrina T. De Cillis More articles by this author Alberto Piana More articles by this author Gabriele Volpi More articles by this author Michele Sica More articles by this author Paolo Verri More articles by this author Mariano Burgio More articles by this author Juliette Meziere More articles by this author Giovanni Busacca More articles by this author Edoardo Cisero More articles by this author Luca Marsero More articles by this author Alberto Quarà More articles by this author Marco Colombo More articles by this author Martina Mandaletti More articles by this author Valentina Garzena More articles by this author Bianca S. Ribolzi More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...
Piramide et al. (Mon,) studied this question.