目的:泌尿外科二维(2D)成像的三维(3D)虚拟重建的日益普及导致了重大的技术进步,从而创建高度精确的3D虚拟模型(3DVM),忠实地复制各个解剖细节。这项技术增强了手术的现实,为外科医生提供对瞬时主观手术解剖结构的超精确见解,并改善术前手术计划。在肿瘤领域,3D虚拟重建的实用性已在保留肾单位的手术中得到证明,影响前列腺癌(PCa)的手术策略和术后结局。这项研究的目的是对3D重建和增强现实(AR)在根治性前列腺切除术(RP)中的现状和应用进行全面的叙述性回顾。
方法:使用Medline进行非系统文献综述,PubMed,Cochrane数据库,和Embase收集临床试验信息,随机对照试验,评论文章,以及与RP中3DVM和AR相关的前瞻性和回顾性研究。搜索策略遵循PICOS(患者,干预,比较,结果,研究设计)标准,并于2024年1月进行。
■3D可视化的采用已变得广泛,应用范围从术前计划到术中咨询。泌尿外科社区对术中手术导航使用认知,虚拟,混合,RP期间的AR在大量文献中很明显,包括16项值得注意的调查。这些研究强调了将3D重建和AR整合到RP中的各种经验和好处,展示术前计划的改进,术中导航,和实时决策。
结论:3DVM和AR技术在泌尿外科肿瘤中的整合,特别是在RP的背景下,已经显示出有希望的进步。这些技术为术前计划提供了至关重要的支持,术中导航,和实时决策,显着改善复杂解剖结构的可视化,有助于神经保留(NS)方法调制并降低阳性手术切缘(PSM)率。尽管取得了积极成果,挑战,如小型患者队列,缺乏标准化的方法,对成本和技术采用的担忧持续存在。
OBJECTIVE: The increasing popularity of three-dimensional (3D) virtual reconstructions of two-dimensional (2D) imaging in urology has led to significant technological advancements, resulting in the creation of highly accurate 3D virtual models (3DVMs) that faithfully replicate individual anatomical details. This technology enhances surgical reality, providing surgeons with hyper-accurate insights into instantaneous subjective surgical anatomy and improving preoperative surgical planning. In the uro-oncologic field, the utility of 3D virtual reconstruction has been demonstrated in nephron-sparing surgery, impacting surgical strategy and postoperative outcomes in prostate cancer (PCa). The aim of this study is to offer a thorough narrative review of the current state and application of 3D reconstructions and augmented reality (AR) in radical prostatectomy (RP).
METHODS: A non-systematic literature review was conducted using Medline, PubMed, the Cochrane Database, and Embase to gather information on clinical trials, randomized controlled trials, review articles, and prospective and retrospective studies related to 3DVMs and AR in RP. The search strategy followed the PICOS (Patients, Intervention, Comparison, Outcome, Study design) criteria and was performed in January 2024.
UNASSIGNED: The adoption of 3D visualization has become widespread, with applications ranging from preoperative planning to intraoperative consultations. The urological community\'s interest in intraoperative surgical navigation using cognitive, virtual, mixed, and AR during RP is evident in a substantial body of literature, including 16 noteworthy investigations. These studies highlight the varied experiences and benefits of incorporating 3D reconstructions and AR into RP, showcasing improvements in preoperative planning, intraoperative navigation, and real-time decision-making.
CONCLUSIONS: The integration of 3DVMs and AR technologies in urological oncology, particularly in the context of RP, has shown promising advancements. These technologies provide crucial support in preoperative planning, intraoperative navigation, and real-time decision-making, significantly improving the visualization of complex anatomical structures helping in the nerve sparing (NS) approach modulation and reducing positive surgical margin (PSM) rate. Despite positive outcomes, challenges such as small patient cohorts, lack of standardized methodologies, and concerns about costs and technology adoption persist.