Step-by-step optimisation of robotic-assisted radical prostatectomy using augmented reality

Abstract

_______________________________________________________________________________________Introduction: Surgical training will be complemented by digitalisation, as the COVID 19 pandemic continues (1). Proximie is an augmented reality (AR) platform that can display up to 4 native camera views, with live or semi live telementoring. It can optimise ergonomics of the surgeon at the console (2), and robotic instrument orientation. We describe the utilisation of Proximie as a step-by-step guide in a robotic assisted radical prostatectomy (RARP). Surgical Technique: Author V. P. performed a transperitoneal multiport da Vinci Xi RARP with the Proximie platform: a laptop computer, multiple HD webcams, microphones and speakers. Using an HDMI cable to the Intuitive Surgical tower, output display from the console and an additional laparoscopic tower is shown. Each webcam was mounted to the side armrests of the console, directed at the surgeon's hands. An independent 'drop in' laparoscope via an additional 5mm left upper quadrant port was utilised. Observers can visualise the AR platform's recordings on a laptop and/or smartphone. A PTZ (pan-tilt-zoom) camera can capture the operating room, bedside assistant, ports and patient position. Our video demonstrates three of four camera views for posture, forearm, wrist, hand, and finger orientation, relative to the translated robotic steps. A pincer grasp of the endowrist manipulator during anastomosis allows optimal robotic wrist rotation. The second laparoscopic camera view demonstrated intracorporeal angles of robotic arm and bedside assistant's instrument position for critical steps such as nerve sparing and anastomosis (3). The console time was 100 minutes, no intraoperative complications, or delay in image transmission occurred with utilising the platform. Considerations: An AR platform can create deeper learning for RARP in real time or recorded sessions. Two-way verbal and visual communication with ability to annotate on screen, allows long distance mentoring. The platform's utility can be accessed in anywhere, to project surgeons beyond their immediate environment. This allows for democratisation of access to high volume institutions and their evolution of techniques (4), to assist patients globally. Potential developments are artificial intelligence (AI) networks analysing repository of such recorded data, to identify intraoperative hand motion and robotic instrument tracking. AR is a pertinent building block to enhance robotic training, skill dissemination, precision medicine (5) and surgery overall.

A Systematic Review of New Imaging Technologies for Robotic Prostatectomy: From Molecular Imaging to Augmented Reality

“…As RARP can be recorded including the use of augmented reality platforms, mentoring and teaching is possible from remote, potentially improving diffusion of robotic training beyond centers [ 51 ].…”

Exploring Augmented Reality Integration in Diagnostic Imaging: Myth or Reality?

“…We can highlight several key points regarding the impact of the COVID-19 pandemic on the development of AR applications in healthcare, most of the themes of which relate to diagnostic imaging, as follows [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Exploring new opportunities in healthcare that have never been faced or thought of before [23].…”

“…The compilation of studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] presents a rich tapestry of potential applications emerging from current research endeavors.…”

“…This innovation, tailored to the exigencies of the pandemic, promises enhanced visualization and interpretation of CT scans, thereby aiding disease management and treatment planning. In the realm of surgical precision, study [32] delineates the optimization of robotic-assisted radical prostatectomy through augmented reality. AR technologies emerge as indispensable tools for surgical planning, navigation, and intraoperative guidance, fostering enhanced precision and favorable patient outcomes amidst pandemic-induced resource constraints.…”