67th Annual Meeting Abstracts

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Tandem-Robot Assisted Laparoscopic Radical Prostatectomy (T-RALP) to improve the Neurovascular Bundle Visualization: A Feasibility Study
Misop Han, *Bruce Trock, *Doru Petrisor, *Chunwoo Kim, *Dan Stoianovici
Johns Hopkins University, Baltimore, MD

Introduction:
Robot-assisted laparoscopic radical prostatectomy (RALP) is a commonly performed surgery for prostate cancer treatment. The preservation of the neurovascular bundle (NVB) during the surgery improves the postoperative recovery of sexual potency. The blood vessels in the NVB, which are visible with Doppler ultrasound, can serve as a macroscopic landmark to localize the microscopic cavernous nerves in the NVB. In this feasibility study, a novel, robotic-transrectal ultrasound probe manipulator (TRUS Robot) and 3-D reconstruction software were used concurrently with the daVinci^® robot in a tandem robot approach (T-RALP) to enable the intraoperative use of TRUS for image-guidance navigation.
Materials & Methods:
After IRB and FDA approval, we performed T-RALP on three subjects with prostate cancer. TRUS Robot provided a steady holding of the TRUS probe and allowed remote manipulation using a joystick located next to the daVinci^® console.
Results:
All subjects underwent T-RALP without associated complications. TRUS Robot was able to track the accurate position of the TRUS probe, allowing 3-D reconstruction of the images. Image navigation was then performed by observing the surgical instruments in the live TRUS image. NVBs were clearly visualized in the 3-D reconstruction.
Conclusions:
In this feasibility study, intraoperative 3-D image-guided navigation system was developed. TRUS imaging during surgery can potentially improve the visualization of the NVB and provide accurate guidance of surgical landmarks to the surgeon.

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