|Year : 2006 | Volume
| Issue : 4 | Page : 382
Real-time transrectal ultrasound: An adjunct to nervesparing laparoscopic radical prostatectomy
Rajiv Goyal, Aneesh Srivastava
Department of Urology and Renal Transplant, SGPGIMS, Lucknow, India
Department of Urology and Renal Transplant, SGPGIMS, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goyal R, Srivastava A. Real-time transrectal ultrasound: An adjunct to nervesparing laparoscopic radical prostatectomy. Indian J Urol 2006;22:382
Ukimura O, Gill IS. Real-time transrectal ultrasound guidance during nerve sparing laparoscopic radical prostatectomy: Pictorial essay. J Urol 2006;175:1311-9.
| Summary|| |
The authors of this study report that real-time transrectal ultrasound (TRUS) can visualize prostate / peri prostatic anatomy and provide intraoperative navigation during nerve-sparing laparoscopic radical prostatectomy (LRP). Gray-scale ultrasound (7.5 MHz) and power Doppler ultrasound were used in 77 consecutive men for transperitoneal LRP. Real-time TRUS monitoring was performed preoperatively, intraoperatively and immediately postoperatively. Emphasis was placed on identifying the neurovascular
bundles, defining the prostate apex contour and evaluating the location and extent of any hypoechoeic cancer nodules. Intraoperative TRUS navigation appeared to be helpful for certain specific technical aspects of LRP, including 1) the identification of hypoechoeic prostate cancer nodules 2) precision during lateral pedicle transaction and neurovascular bundle release 3) calibrated, wider dissection at the site of suspected extra-capsular extension of cancer nodules to achieve negative margins 4) tailored dissection according to the individual prostate apex and (5) facilitation of posterior bladder neck transaction for the novice. Real-time TRUS monitoring of the location of the laparoscopic scissors tip (hyperechoic spot) in regard to the safe dissection plane at the concerned anatomical site was feasible. Blood flow in the neurovascular bundles before, during and after nerve-sparing LRP was documented.
| Comments|| |
Tactile feedback is somewhat attenuated during laparoscopic vs. open surgery. Real-time intraoperative TRUS guidance during LRP may help offset this perceived technical disadvantage. The potential benefit of TRUS is accurate real-time localization of the global prostate contour to guide dissection along the optimal oncological plane, while minimizing injury to peri prostatic anatomy, especially to the NVB and membranous urethra., In this analysis the incidence of positive margin rates improved from 29 to 9%. The positive predictive value of TRUS for diagnosing ECE was 74%. Clearly, the greatest potential benefit of intraoperative TRUS is primarily in patients with a HEL with ECE (pT3a disease). Additionally, patients with higher risk cancers (higher PSA, higher Gleason score and prostate nodule on digital rectal examination) may likely benefit from TRUS navigation.
This study provides initial proof of concept regarding the feasibility of real-time navigation to enhance intraoperative surgical performance. The reproducibility and inter-operator reliability of TRUS navigation and the pathological corroboration of TRUS-suspected ECE needs to be confirmed in a large number of patients. An increased burden of cost and expertise could be other factors which need to be addressed.
| References|| |
|1.||Ukimura O, Gill IS, Desai MM, Steinberg AP, Kilciler M, Ng CS, et al . Real-time transrectal ultrasonography during laparoscopic radical prostatectomy. J Urol 2004;172:112-8. |
|2.||Gill IS, Ukimura O, Rubinstein M, Finelli A, Moinzadeh A, Singh D, et al . Lateral pedicle control during laparoscopic radical prostatectomy: Refined technique. Urology 2005;65:23-7. |
|3.||Ukimura O, Magi-Galluzzi C, Gill IS. Real-time transrectal ultrasound guidance during laparoscopic radical prostatectomy: Impact on surgical margins. J Urol 2006;175:1304-10. [PUBMED] [FULLTEXT]|