gms | German Medical Science

Introduction: The surgical margin in a prostatectomy is a surrogate for recurrence-free survival. The utilization of frozen section in a prostatectomy has enabled us to allow for intraoperative decision-making. There is a potential discrepancy between perceived surgical margin and the pathological assessment. We have developed a technology with the potential to overcome this shortcoming.

Material and Methods: We have built an integrated workflow that includes high resolution photo scanning of the prostatectomy specimen and conversion into a 3D model (photogrammetry), sector based analysis of the prostate and reinsertion of this data platform into the video of the actual surgery. The workflow was applied to selected 10 patients who underwent a robot-assisted radical nerve-sparing prostatectomy.

Results: In all 10 cases, we were able to identify the surgical margin on the 3D model. This allowed for a transfer of the pathological evaluation to the 3D model. In 5 cases the intraoperative margin warranted a resection of additional tissue of the neurovascular bundle. Based on the 3D reconstruction model and the corresponding pathologic analysis we were able to correctly identify the lesion involving the margin status in the video of the operation.

Conclusions: We are able to visualize pathological findings on the 3D model and reliably identify surgical margins in a consecutive series of 10 patients. Our procedure is reliable and reproducible despite a substantial level of technical complexity. It should be further investigated whether the 3D visualization of the pathological findings and the associated retrospective processing of the operation results in a positive impact on the learning curve of a surgeon thus potentially improving the quality of the surgical technique.