3D printed patient-specific prostate cancer models to guide nerve-sparing robot-assisted radical prostatectomy: a systematic review

Frontiers and hotspots of 3D technology in prostatectomy from 1999 to 2024: a bibliometric analysis and visualization

Background

Prostate cancer is a major global health issue. Radical prostatectomy is an effective treatment for prostate cancer. The integration of three-dimensional (3D) technology in prostatectomy offers numerous benefits. We intended to perform a bibliometric analysis of the role of 3D technology in prostatectomy.

Methods

Articles and review articles related to "3D" and "prostatectomy" were retrieved from Web of Science Core Collection. Microsoft Office Excel, CiteSpace, and VOSviewer were utilized for analysis and visualization.

Results

A total of 441 articles were collected. The annual publication volume and journal distribution were illustrated. Visualizations of collaborations among countries/regions, institutions, and authors were provided. Networks of reference co-citations and keyword co-occurrences, along with their respective clusters were plotted.

Conclusions

The number of published papers significantly increased over the last 25 years. The most productive and influential country was the USA, and The University of California System was the most influential institution. The journal with the highest number of publications was BJU International. Among all authors in this field, Wijkstra H has published the most papers. Porpiglia F was the most cited author. Previous hot topics included advanced imaging and clinical trials, whereas augmented reality (AR) and robotics are likely to be hot topics in the future.

Single-Port Robotic Transvesical Partial Prostatectomy: A Novel Approach for Focal Treatment in Prostate Cancer

Introduction and Objective: Given the favorable cancer-specific survival rates in localized prostate cancer and the negative impact of whole-gland treatments on functional outcomes, the field is moving toward precision strategies such as focal therapy and organ-sparing surgery. We aim to report medium-term functional and oncologic outcomes for the initial Single-Port Robotic Transvesical Partial Prostatectomy (SP-TVRAPP) patient cohort. Materials and Methods: We analyzed a prospectively maintained database of 20 patients who underwent SP-TVRAPP between February 2021 and March 2024. Inclusion criteria were prostate-specific antigen (PSA) ≤10 ng/mL, clinical stage ≤ cT2b, ISUP Grade Group ≤3, unilateral lesions on multiparametric magnetic resonance imaging (mpMRI) with positive biopsy cores on the same side, and preoperative IIEF-5 ≥ 17. We also considered bilateral prostate cancer in the anterior zone and invisible mpMRI tumors confirmed by unilateral positive biopsies. Results: At baseline, patients had an average age of 61 years, a median PSA of 4.8 ng/mL (interquartile range [IQR]: 3.7-7.7), and a median Sexual Health Inventory for Men (SHIM) score of 24 (IQR: 18-25). All procedures were completed without complications, need for additional ports, or conversion. After a median hospital stay of 4.2 hours, 94% of cases were discharged without opioid prescriptions, and Foley catheters were removed after approximately 4 days. At 6 weeks, 3, 6, and 12 months postprocedure, potency rates, defined as a SHIM score ≥17, were 45.0%, 77.7%, 83.3%, and 87.5%, respectively. When potency was defined as having erections sufficient for penetration, the rates were 80.0%, 88.8%, 88.8%, and 93.7% for the same time intervals. Regarding urinary function, 60.0% were continent at 1 week, increasing to 85.0% by 6 weeks, 88.8% at both 3 and 6 months, and reaching 93.7% at 12 months postsurgery. Oncologically, 30.0% experienced upgrading and 40.0% upstaging within this cohort. Negative surgical margins were attained in 85.0% of the cases and the median PSA was 0.4 ng/mL 12 months after SP-TVRAPP. Two men were found to have residual GG1 cancer in the protocol biopsies and are currently on active surveillance. At a mean follow-up of 15.5 months (0.2-34.8) months, none of the patients has required secondary interventions, and all remain free of both clinically significant residual prostate cancer and metastatic disease. Conclusions: SP-TVRAPP represents a promising treatment for certain patients with localized prostate cancer. This targeted surgical method has been associated with faster postoperative recovery and has demonstrated high rates of early recovery in erectile function and urinary continence while ensuring oncologic safety.

A new mixed reality tool for training in minimally invasive robotic-assisted surgery

Robotic-assisted surgery (RAS) is developing an increasing role in surgical practice. Therefore, it is of the utmost importance to introduce this paradigm into surgical training programs. However, the steep learning curve of RAS remains a problem that hinders the development and widespread use of this surgical paradigm. For this reason, it is important to be able to train surgeons in the use of RAS procedures. RAS involves distinctive features that makes its learning different to other minimally invasive surgical procedures. One of these features is that the surgeons operate using a stereoscopic console. Therefore, it is necessary to perform RAS training stereoscopically. This article presents a mixed-reality (MR) tool for the stereoscopic visualization, annotation and collaborative display of RAS surgical procedures. The tool is an MR application because it can display real stereoscopic content and augment it with virtual elements (annotations) properly registered in 3D and tracked over time. This new tool allows the registration of surgical procedures, teachers (experts) and students (trainees), so that the teacher can share a set of videos with their students, annotate them with virtual information and use a shared virtual pointer with the students. The students can visualize the videos within a web environment using their personal mobile phones or a desktop stereo system. The use of the tool has been assessed by a group of 15 surgeons during a robotic-surgery master's course. The results show that surgeons consider that this tool can be very useful in RAS training.