A multiparametric magnetic resonance imaging-based virtual reality surgical navigation tool for robotic-assisted radical prostatectomy

Özet

Objective: Increased computational power and improved visualization hardware have generated more op-portunities for virtual reality (VR) applications in healthcare. In this study, we test the feasibility of a VR-assisted surgical navigation system for robotic-assisted radical prostatectomy.Material and methods: The prostate, all magnetic resonance imaging (MRI) visible tumors, and importantanatomic structures like the neurovascular bundles, seminal vesicles, bladder, and rectum were contoured ona multiparametric MRI using an in-house segmentation software. Three-dimensional (3-D) VR models wererendered and evaluated in a side room of the operating room. While interacting with the VR platform, a real-time stereo video capture of the in situ prostate was obtained to render a second 3-D model. The MRI-basedmodel was then overlaid on the real-time model by using an automated alignment algorithm.Results: Ten patients were included in this study. All MRI-based VR models were examined by surgeonsimmediately prior to surgery and at important steps where visualization of the tumors and their proximityto surrounding anatomic structures were critical. This was mainly during the preparation of the prostaticpedicles, neurovascular plexus, the apex, and bladder neck. All participants found the system useful, espe-cially for tumors with locally aggressive growth patterns. For small and centrally located tumors, the systemwas not considered beneficial due to lack of integration into the robotic console. A fully integrated systemwith real-time overlays within the robotic stereo viewer was found to be the ideal scenario.Conclusion: We deployed a preliminary VR-assisted surgical navigation tool for robotic-assisted radicalprostatectomies.