Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy
Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy
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DOI：
10.1016/j.juro.2015.10.182
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发表时间：
2016-04-01
影响因子：
6.6
通讯作者：
Liao, Joseph C.
中科院分区：
文献类型：
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作者：
Lopez, Aristeo;Zlatev, Dimitar V.;Liao, Joseph C.
目的：术中光学活检技术可能有助于识别重要的解剖标志并改善机器人辅助根治性前列腺切除术的手术结果。我们评估了机器人辅助根治性前列腺切除术中共聚焦激光内窥镜检查的可行性。材料和方法：总共招募了 21 名活检证实患有前列腺癌并计划进行机器人辅助根治性前列腺切除术的患者。静脉注射荧光素后，15 名患者使用 2.6 或 0.85 mm 成像探针对前列腺和前列腺周围结构进行体内术中共聚焦激光内窥镜检查。使用标准机器人仪器来抓取和操纵共焦激光内窥镜探头以获取图像。对 20 名患者的新鲜前列腺标本进行离体共聚焦激光内窥镜成像。对体内和体外获得的共焦视频序列进行了审查和分析，并使用镶嵌算法进行了额外的图像处理。将处理后的共焦图像与成像区域的标准苏木精和伊红分析进行比较。结果：共焦激光内窥镜成功地与机器人手术集成，包括用白光共同配准共焦视频序列以及用标准机器人仪器处理探针。神经保留解剖前后神经血管束的术中共焦激光内窥镜成像揭示了特征性特征，包括动态血管血流和完整的轴突纤维。前列腺实质的离体共聚焦成像显示正常的前列腺、间质和前列腺癌。结论：我们报告了在机器人辅助根治性前列腺切除术中对前列腺和前列腺周围组织进行光学活检的初步可行性。使用共焦激光内窥镜的图像引导和组织询问提供了一种新的术中成像方法，有可能改善前列腺癌手术的功能和肿瘤学结果。
Purpose: Intraoperative optical biopsy technologies may aid in the identification of important anatomical landmarks and improve surgical outcomes of robotic assisted radical prostatectomy. We evaluate the feasibility of confocal laser endomicroscopy during robotic assisted radical prostatectomy.Materials and Methods: A total of 21 patients with biopsy proven prostate cancer scheduled for robotic assisted radical prostatectomy were recruited. After intravenous administration of fluorescein 15 patients underwent in vivo intra-operative confocal laser endomicroscopy of prostatic and periprostatic structures using a 2.6 or 0.85 mm imaging probe. Standard robotic instruments were used to grasp and maneuver the confocal laser endomicroscopy probes for image acquisition. Confocal laser endomicroscopy imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions.Results: Confocal laser endomicroscopy was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative confocal laser endomicroscopy imaging of the neurovascular bundle before and after nerve sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated normal prostate glands, stroma and prostatic carcinoma.Conclusions: We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during robotic assisted radical prostatectomy. Image guidance and tissue interrogation using confocal laser endomicroscopy offer a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery.