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Zuluaga L, Rich JM, Gupta R, Pedraza A, Ucpinar B, Okhawere KE, Saini I, Dwivedi P, Patel D, Zaytoun O, Menon M, Tewari A, Badani KK. AI-powered real-time annotations during urologic surgery: The future of training and quality metrics. Urol Oncol 2024; 42:57-66. [PMID: 38142209 DOI: 10.1016/j.urolonc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION AND OBJECTIVE Real-time artificial intelligence (AI) annotation of the surgical field has the potential to automatically extract information from surgical videos, helping to create a robust surgical atlas. This content can be used for surgical education and qualitative initiatives. We demonstrate the first use of AI in urologic robotic surgery to capture live surgical video and annotate key surgical steps and safety milestones in real-time. SUMMARY BACKGROUND DATA While AI models possess the capability to generate automated annotations based on a collection of video images, the real-time implementation of such technology in urological robotic surgery to aid surgeon and training staff it is still pending to be studied. METHODS We conducted an educational symposium, which broadcasted 2 live procedures, a robotic-assisted radical prostatectomy (RARP) and a robotic-assisted partial nephrectomy (RAPN). A surgical AI platform system (Theator, Palo Alto, CA) generated real-time annotations and identified operative safety milestones. This was achieved through trained algorithms, conventional video recognition, and novel Video Transfer Network technology which captures clips in full context, enabling automatic recognition and surgical mapping in real-time. RESULTS Real-time AI annotations for procedure #1, RARP, are found in Table 1. The safety milestone annotations included the apical safety maneuver and deliberate views of structures such as the external iliac vessels and the obturator nerve. Real-time AI annotations for procedure #2, RAPN, are found in Table 1. Safety milestones included deliberate views of structures such as the gonadal vessels and the ureter. AI annotated surgical events included intraoperative ultrasound, temporary clip application and removal, hemostatic powder application, and notable hemorrhage. CONCLUSIONS For the first time, surgical intelligence successfully showcased real-time AI annotations of 2 separate urologic robotic procedures during a live telecast. These annotations may provide the technological framework for send automatic notifications to clinical or operational stakeholders. This technology is a first step in real-time intraoperative decision support, leveraging big data to improve the quality of surgical care, potentially improve surgical outcomes, and support training and education.
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Affiliation(s)
- Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY.
| | - Jordan Miller Rich
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Raghav Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Adriana Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Priyanka Dwivedi
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Dhruti Patel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
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Boni A, Gervasoni F, Lomauro A, Del Zingaro M, Maiolino G, Galletti C, Ricci V, Mearini E. Urologic latency time during uroflow stop test with electromyography: an incontinence detector in rehabilitation after robotic radical prostatectomy. Eur J Phys Rehabil Med 2023; 59:94-102. [PMID: 36305651 PMCID: PMC10035442 DOI: 10.23736/s1973-9087.22.07365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stress urinary incontinence (UI) is the most common presentation following robot-assisted radical prostatectomy (RARP), but a postoperative non-invasive and objective test is still lacking. To assess pelvic floor integrity after RARP, we recently proposed Uroflow Stop Test (UST) with surface electromyography (EMG). AIM Here we provide two new clinical parameters: the neurologic latency time (NLT) and the urologic latency time (ULT) derived from UST-EMG Test. Principal outcome was to evaluate their variation during one year follow-up and ULT ability to predict post-RARP UI. DESIGN Observational and longitudinal study. SETTING Interdivisional Urology Clinic (Perugia-Terni, Italy). POPULATION Patients with prostate cancer treated with a full nerve-sparing RARP who underwent postoperative pelvic floor muscles training (PFMT): a diurnal functional home program and a weekly hospital program with the use of biofeedback, between 1 and 3 months postoperatively. METHODS All patients consecutively performed a UST-EMG test at one, three, six, and twelve months after surgery. At each follow-up visit we collected NLT values, ULT values, 5-item 26-Expanded Prostate Cancer Index (EPIC), Incontinence Developed on Incontinence Questionnaire (ICIQ-UI) Short Form and International Prostate Symptom Score (IPSS). We analysed statistically significant differences in NLT and ULT between continent and incontinent patients and we evaluate the diagnostic ability of 1-month post-surgery ULT value to diagnose the presence of postoperative UI. RESULTS Sixty patients were enrolled. The mean time to PFMT was 31.08 (range: 30-35) days. Overall IPSS, NLT and ULT had similar trends: progressive decrease until the six months after surgery (1-month vs. 3 months vs. 6 months, P<0.05) to plateau thereafter. When considering the two group of patients, IPSS and NLT were significantly higher in the incontinent group only one month after surgery, while ULT became similar between the two groups at 6 months after surgery. The best cut-off of 1-month ULT values that maximized the Youden function at 12-months resulted 3.13 second. CONCLUSIONS NLT and ULT may respectively account for the nerve and the urethral closure system integrity post-RARP. In the first month after RARP, both NLT and ULT differs between incontinent vs. continent patients. NLT become similar between two group after one month, confirming the recovery from neuropraxia, but ULT remains statistically significant different until 3 months postoperatively. The value of 1-month ULT resulted a valid tool to predict incontinence status at 12 months. CLINICAL REHABILITATION IMPACT ULT and NLT may be also useful tools to monitor the continence progressive recovery after RARP and they may help rehabilitation specialists to evaluate the ongoing results during postoperative follow-up.
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Affiliation(s)
- Andrea Boni
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Fabrizio Gervasoni
- Unit of Rehabilitation, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy
| | - Antonella Lomauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy -
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
| | - Chiara Galletti
- Department of Psychiatry, Santa Maria University Hospital, Terni, Italy
| | - Vincenzo Ricci
- Unit of Rehabilitation, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Interdivisional Urology Clinic (Perugia-Terni), University Hospital of Perugia, Perugia, Italy
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Zhang H, Ning Z, Jia G, Zhang G, Wang J, Liu H, Tao B, Wang C. Modified hood technique for single-port robot-assisted radical prostatectomy contributes to early recovery of continence. Front Surg 2023; 10:1132303. [PMID: 37206347 PMCID: PMC10189123 DOI: 10.3389/fsurg.2023.1132303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/19/2023] [Indexed: 05/21/2023] Open
Abstract
Background and purpose Urinary incontinence is one of the common side effects of robot-assisted radical prostatectomy (RARP). Here, we described the modified Hood technique for single-port RARP (sp-RARP) and assessed the interest of this new technique for early continence recovery. Methods We retrospectively reviewed 24 patients who underwent sp-RARP modified hood technique from June 2021 to December 2021. The pre-and intraoperative variables, postoperative functional and oncological outcomes of patients were collected and analyzed. The continence rates were estimated at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal. Continence was defined as wearing no pad over a 24 h period. Results Mean time of operation and estimated blood loss were 183 min and 170 ml, respectively. The postoperative continence rates at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal were 41.7%, 54.2%, 75.0%, 91.7% and 95.8%, respectively. There were two patients who detected positive surgical margins and no patients observed complications requiring further treatment. Conclusion The modified hood technique is a safe and feasible method that provides better outcomes in terms of early return of continence, without increasing estimated blood loss and compromising oncologic outcomes.
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Affiliation(s)
- Haoxun Zhang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zikuan Ning
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guang Jia
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guoling Zhang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiuliang Wang
- Department of Operating Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hua Liu
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Chunyang Wang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
- Correspondence: Chunyang Wang
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Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020; 9:3036-3048. [PMID: 33457277 PMCID: PMC7807332 DOI: 10.21037/tau.2020.03.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients’ quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
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Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020. [PMID: 33457277 DOI: 10.21037/tau.2020.03.36)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients' quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
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Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Shin TY, Lee YS. Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes. Sci Rep 2020; 10:17595. [PMID: 33077779 PMCID: PMC7573617 DOI: 10.1038/s41598-020-74513-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/29/2020] [Indexed: 11/09/2022] Open
Abstract
Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP). The clipless intrafascial neurovascular bundle-sparing technique aims to preserve periprostatic structures and neurovascular bundles as much as possible by avoiding clipping of the vascular pedicles. This study reports 1-year functional and oncologic outcomes and postoperative complications in 105 patients with intact preoperative erectile function who underwent a modified clipless intrafascial neurovascular bundle-sparing RARP. Intact erectile function was defined as score ≥ 21 on the Sexual Health Inventory for Men questionnaire or ability to have sexual intercourse. Median follow-up was 26.5 months (IQR 15.25-48). Postoperative erectile function recovery rates were 71.4%, 81.9%, 88.6%, 92.4%, and 94.3% at 1, 3, 6, 9, and 12 months, respectively. The rate of positive surgical margins was 16.2% overall and 11.8% in patients with stage pT2 disease. The biochemical recurrence rate was 6.7% overall. The modified clipless intrafascial neurovascular bundle-sparing technique is safe and feasible and can achieve excellent recovery of erectile function after RARP. Further large-scale prospective comparative studies are warranted.
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Affiliation(s)
- Tae Young Shin
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 14068, Republic of Korea
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 14068, Republic of Korea.
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Zattoni F, Artibani W, Patel V, Montorsi F, Porpiglia F, Hampton LJ, Rocco B, Dasgupta P, Hemal AK, Mottrie A, Tewari A, Dal Moro F. Technical innovations to optimize continence recovery after robotic assisted radical prostatectomy. MINERVA UROL NEFROL 2019; 71:324-338. [DOI: 10.23736/s0393-2249.19.03395-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Detrusorrhaphy during Robot-Assisted Radical Prostatectomy: Early Recovery of Urinary Continence and Surgical Technique. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1528142. [PMID: 30891454 PMCID: PMC6390270 DOI: 10.1155/2019/1528142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/30/2019] [Indexed: 01/14/2023]
Abstract
Robot-assisted radical prostatectomy (RARP) has largely replaced open radical prostatectomy as the standard surgical treatment for prostate cancer. However, postoperative urinary incontinence still persists and has a significant impact on quality of life. We report the superior results of the detrusorrhaphy technique during RARP that helps achieve early continence. Our prospective study involved 95 consecutive patients who underwent RARP between March 2015 and May 2017; fifty patients underwent RARP using the new detrusorrhaphy technique (group 1) and 45 underwent standard RARP (group 2). The postoperative oncological and functional outcomes were compared between the two groups. The postoperative continence was assessed at 0 day, 1 week, 4 weeks, 8-12 weeks, and 6 months after catheter removal. Continence was defined as the use of no pad over a 24 h period. Mean operative time in groups 1 and 2 were 250 and 220 min, respectively. Intraoperative complications were not encountered in any patient. The continence rates after catheter removal in groups 1 and 2 were 68% and 0% at 0 day, 78% and 17.8% at 1 week, 86% and 64.4% at 4 weeks, 92% and 73.3% at 8-12 weeks, and 100% and 91.1% at 6 months, respectively. In the multivariate analysis, the nerve sparing technique, D'Amico risk groups, and prostate volume were involved in the early recovery of urinary continence. The detrusorrhaphy technique is simple, safe, and feasible, which helped achieve earlier continence. It showed significantly better outcomes than those achieved with the standard RARP technique in terms of urinary incontinence. Nevertheless, our findings need to be validated in further studies.
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Manfredi M, Fiori C, Amparore D, Checcucci E, Porpiglia F. Technical details to achieve perfect early continence after radical prostatectomy. MINERVA CHIR 2019; 74:63-77. [DOI: 10.23736/s0026-4733.18.07761-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Neural supply of the male urethral sphincter: comprehensive anatomical review and implications for continence recovery after radical prostatectomy. World J Urol 2016; 35:549-565. [DOI: 10.1007/s00345-016-1901-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/16/2016] [Indexed: 11/25/2022] Open
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Lim SK, Kim KH, Shin TY, Han WK, Chung BH, Hong SJ, Choi YD, Rha KH. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 2014; 114:236-44. [DOI: 10.1111/bju.12705] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sey Kiat Lim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
- Department of Urology; Changi General Hospital; Singapore
| | - Kwang Hyun Kim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Tae-Young Shin
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Woong Kyu Han
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Byung Ha Chung
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Sung Joon Hong
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Young Deuk Choi
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Koon Ho Rha
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
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