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Image-guided robotic interventions for prostate cancer

Nature Reviews Urology volume 10, pages 452–462 (2013)Cite this article

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Abstract

Robotic prostatectomy is a common surgical treatment for men with prostate cancer, with some studies estimating that 80% of prostatectomies now performed in the USA are done so robotically. Despite the technical advantages offered by robotic systems, functional and oncological outcomes of prostatectomy can still be improved further. Alternative minimally invasive treatments that have also adopted robotic platforms include brachytherapy and high-intensity focused ultrasonography (HIFU). These techniques require real-time image guidance—such as ultrasonography or MRI—to be truly effective; issues with software compatibility as well as image registration and tracking currently limit such technologies. However, image-guided robotics is a fast-growing area of research that combines the improved ergonomics of robotic systems with the improved visualization of modern imaging modalities. Although the benefits of a real-time image-guided robotic system to improve the precision of surgical interventions are being realized, the clinical usefulness of many of these systems remains to be seen.

Key Points

  • Precise treatment techniques are critical for improving the oncological and functional outcomes of men with prostate cancer; urologists are increasingly performing robot-assisted surgeries, which benefit from reduced tremor and improved field of view

  • Image-guided robotic surgery is expanding in use. Although MRI guidance is more accurate than ultrasonography, it is still operator-dependent and has ergonomic issues owing to the scanner design

  • MRI coupled with transrectal ultrasonography (TRUS) might be a practical alternative to MRI guidance, as it has demonstrated improved sensitivity and specificity over TRUS alone in biopsy and could be applied to robot-assisted brachytherapy and focal ablation

  • Specially designed image-guided robotic platforms for low-dose brachytherapy and prostate biopsy have demonstrated the ability to place brachytherapy seeds accurately and automatically, reducing the exposure of the operator to radiation

  • Initial clinical studies have demonstrated the ability of image guidance during robot-assisted laparoscopic prostatectomy to reduce the rate of positive surgical margins and improve the visualization of key anatomical structures

  • Novel imaging techniques such as fluorescence imaging and ultra-small particles of iron-oxide (USPIO) have opened up the possibility of image-guided targeted robotic lymph node dissection

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Figure 1: Augmented reality image guidance in radical prostatectomy.
Figure 2: TRUS-guided robotic systems have been developed for prostate biopsy, and could be used for guided brachytherapy.
Figure 3: Positioning of an MRI robot for prostate intervention.
Figure 4: MRI–TRUS fusion.
Figure 5: Example of system architecture, illustrating stereo video pathways, for image guidance in robot-assisted laparoscopic procedures.

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Authors and Affiliations

  1. Department of Surgery & Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK

    Ashwin N. Sridhar, Archie Hughes-Hallett, Erik K. Mayer, Philip J. Edwards, Ara W. Darzi & Justin A. Vale

  2. Hamlyn Centre for Robotic Surgery, Bessemer Building, South Kensington Campus, Imperial College London, Exhibition Road, London, SW7 2AZ, UK

    Philip J. Pratt & Guang-Zhong Yang

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  1. Ashwin N. Sridhar
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A. N. Sridhar and A. Hughes-Hallett contributed equally to this manuscript. A. N. Sridhar and A. Hughes-Hallett researched the data for the article. A. N. Sridhar, A. Hughes-Hallett, E. K. Mayer and P. J. Pratt discussed the article's content, after which A. N. Sridhar, A. Hughes-Hallett and E. K. Mayer wrote the manuscript. All authors edited the manuscript before submission.

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Sridhar, A., Hughes-Hallett, A., Mayer, E. et al. Image-guided robotic interventions for prostate cancer. Nat Rev Urol 10, 452–462 (2013). https://doi.org/10.1038/nrurol.2013.129

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