Development and clinical applicability of MRI-based 3D prostate models in the planning of nerve-sparing robot-assisted radical prostatectomy

Hans Veerman, Thierry N. Boellaard, Jari A. van der Eijk, Judith H. Sluijter, Ton A. Roeleveld, Tim M. van der Sluis, Jakko A. Nieuwenhuijzen, Esther Wit, Maarten J. A. van Alphen, Robert L. P. van Veen, André N. Vis, Henk G. van der Poel, Pim J. van Leeuwen

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2 Citations (Scopus)

Abstract

The interpretation of conventional MRI may be limited by the two-dimensional presentation of the images. To develop patient-specific MRI prostate-based virtual and three-dimensional (3D)-printed models. To assess the association between 3D imaging and the pathological outcome of RARP specimen. To assess the clinical applicability of 3D models to guide nerve-sparing robot-assisted radical prostatectomy (RARP). We created virtual 3D and 3D-printed 3D models of 20 prostate cancer patients retrospectively. A comparison was made between conventional MRI and 3D-reconstructed images. The concordance between tumour lesion location in 3D models and pathology reporting of RARP specimens was assessed. Seven urologists assessed the side-specific extent of nerve-sparing based on (1) conventional MR images, (2) virtual 3D models, and (3) 3D-printed models. Clinically relevant changes in nerve-sparing and the absolute agreement between observers was analyzed using the Chi-square test and intra-class correlation coefficient (ICC). The index lesion was correctly visualized in 19/20 (95%) 3D models and the expected location of extraprostatic extension was correctly visualized in all 3D models. Clinically relevant changes in the planned extent of nerve-sparing between MRI and virtual 3D models and MRI and 3D-printed models were found in 25% and 26%. The ICC of the planned extent of nerve-sparing between urologists was 0.40 (95% CI 0.28–0.55) for conventional MRI, 0.52 (95% CI 0.39–0.66) for virtual 3D models and 0.58 (95% CI 0.45–0.71) for 3D-printed models. 3D models of the MRI prostate to guide RARP could aid urologists in the planning of nerve-sparing surgery as shown by a higher inter-observer agreement.
Original languageEnglish
JournalJournal of Robotic Surgery
Early online date2022
DOIs
Publication statusE-pub ahead of print - 2022

Keywords

  • Magnetic resonance imaging
  • Nerve-sparing
  • Prostate cancer
  • Prostatectomy
  • Three-dimensional images

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