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Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy:A feasibility and accuracy study

引用

Asian Journal of Urology 2023年第4期10卷 407-415页

作者： Enrico Checcucci Alberto Piana Gabriele Volpi Pietro Piazzolla Daniele Amparore Sabrina De Cillis Federico Piramide Cecilia Gatti ilaria stura Enrico Bollito Federica Massa Michele Di Dio Cristian Fiori Francesco Porpiglia Department of Surgery Candiolo Cancer InstituteFPO-IRCCSCandioloTurinItaly Department of Oncology Division of UrologyUniversity of TurinSan Luigi Gonzaga HospitalOrbassanoToItaly Department of Mechanical Engineering Politecnico di MilanoMilanItaly Department of Public Health and Pediatric Sciences School of MedicineUniversity of TurinItaly Department of Pathology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly SS Annunziata Hospital Department of SurgeryDivision of UrologyCosenzaItaly

Objective:To evaluate the accuracy of our new three-dimensional(3D)automatic augmented reality(AAR)system guided by artificial intelligence in the identification of tumour’s location at the level of the preserved neurovascular bundle(NVB)at the end of the extirpative phase of nerve-sparing robot-assisted radical ***:In this prospective study,we enrolled patients with prostate cancer(clinical stages cT1ce3,cN0,and cM0)with a positive index lesion at target biopsy,suspicious for capsular contact or extracapsular extension at preoperative multiparametric magnetic resonance *** underwent robot-assisted radical prostatectomy at San Luigi Gonzaga Hospital(Orbassano,Turin,Italy),from December 2020 to December *** the end of extirpative phase,thanks to our new AAR artificial intelligence driven system,the virtual prostate 3D model allowed to identify the tumour’s location at the level of the preserved NVB and to perform a selective excisional biopsy,sparing the remaining portion of the *** and postoperative data were evaluated,especially focusing on the positive surgical margin(PSM)rates,potency,continence recovery,and biochemical ***:Thirty-four patients were *** 15(44.1%)cases,the target lesion was in contact with the prostatic capsule at multiparametric magnetic resonance imaging(Wheeler grade L2)while in 19(55.9%)cases extracapsular extension was detected(Wheeler grade L3).3D AAR guided biopsies were negative in all pathological tumour stage 2(pT2)patients while they revealed the presence of cancer in 14 cases in the pT3 cohort(14/16;87.5%).PSM rates were 0%and 7.1%in the pathological stages pT2 and pT3(<3 mm,Gleason score 3),***:With the proposed 3D AAR system,it is possible to correctly identify the lesion’s location on the NVB in 87.5%of pT3 patients and perform a 3D-guided tailored nerve-sparing even in locally advanced diseases,without compromising the oncological safety

关键词： Prostate cancer Augmented reality Artificial intelligence Robotics Radical prostatectomy

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