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The evolution of image guidance in robotic-assisted laparoscopic prostatectomy (RALP): a glimpse into the future

  • Review Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Objectives

To describe the innovative intraoperative technologies emerging to aid surgeons during minimally invasive robotic-assisted laparoscopic prostatectomy.

Methods

We searched multiple electronic databases reporting on intraoperative imaging and navigation technologies, robotic surgery in combination with 3D modeling and 3D printing used during laparoscopic or robotic-assisted laparoscopic prostatectomy. Additional searches were conducted for articles that considered the role of artificial intelligence and machine learning and their application to robotic surgery. We excluded studies using intraoperative navigation technologies during open radical prostatectomy and studies considering technology to visualize lymph nodes.

Summary of findings

Intraoperative imaging using either transrectal ultrasonography or augmented reality was associated with a potential decrease in positive surgical margins rates. Improvements in detecting capsular involvement may be seen with augmented reality. The benefit, feasibility and applications of other imaging modalities such as 3D-printed models and optical imaging are discussed.

Conclusion

The application of image-guided surgery and robotics has led to the development of promising new intraoperative imaging technologies such as augmented reality, fluorescence imaging, optical coherence tomography, confocal laser endomicroscopy and 3D printing. Currently challenges regarding tissue deformation and automatic tracking of prostate movements remain and there is a paucity in the literature supporting the use of these technologies. Urologic surgeons are encouraged to improve and test these advanced technologies in the clinical arena, preferably with comparative, randomized, trials.

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Fig. 1

Reproduced with permission from Elsevier Inc [11]

Fig. 2

Reproduced with permission from Elsevier Inc [11]

Fig. 3

Reproduced with permission from Elsevier Inc [23]

Fig. 4

Reproduced with permission from Elsevier Inc [23]

Fig. 5

Reproduced with permission from Springer Nature [27]

Fig. 6

Reproduced with permission from Mary Ann Liebert Inc [29]

Fig. 7

Reproduced with permission from Mary Ann Liebert Inc [34]

Fig. 8

Reproduced with permission from Wolters Kluwer Health Inc [36]

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Availability of data and material

The authors confirm that the data supporting the findings of this study are openly available within this article or those referenced.

Code availability

Not applicable.

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Acknowledgements

We also would like to acknowledge Riccardo Bertolo in assisting in the initial design of this review article.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Royal Prince Alfred Institute of Academic Surgery, Camperdown, Sydney, NSW, 2050, Australia

    Joshua Makary, Danielle C. van Diepen, Jeremy Fallot, Scott Leslie & Ruban Thanigasalam

  2. Concord Repatriation General Hospital, Sydney, NSW, Australia

    Joshua Makary, Danielle C. van Diepen & Ruban Thanigasalam

  3. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Joshua Makary, Scott Leslie & Ruban Thanigasalam

  4. Chris O’Brien Lifehouse, Sydney, NSW, Australia

    Joshua Makary, Ranjan Arianayagam, George McClintock, Jeremy Fallot, Scott Leslie & Ruban Thanigasalam

  5. Erasmus MC Cancer Institute, Erasmus University, Rotterdam, South Holland, The Netherlands

    Danielle C. van Diepen

  6. Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Jeremy Fallot, Scott Leslie & Ruban Thanigasalam

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  1. Joshua Makary
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Correspondence to Joshua Makary.

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This a review article and evidence synthesis of existing, ethically approved data, thus no dedicated ethical approval is required for this study.

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Makary, J., van Diepen, D.C., Arianayagam, R. et al. The evolution of image guidance in robotic-assisted laparoscopic prostatectomy (RALP): a glimpse into the future. J Robotic Surg 16, 765–774 (2022). https://doi.org/10.1007/s11701-021-01305-5

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  • DOI: https://doi.org/10.1007/s11701-021-01305-5

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