Copenhagen, Denmark (UroToday.com) Improvements in surgical techniques and outcomes have come as a result of improved anatomical knowledge gained through ever more powerful imaging techniques. The point of most imaging is to recapitulate patient-specific anatomy so that a surgeon can make the best operative plan and provide the most precise surgery possible for each individual patient.
Dr. Ukimura and colleagues have capitalized on advances in 3D printing technology to take this science to the next level. Using multiparametric MRI imaging as a reference, their team has demonstrated that printing a 3D model of a prostate is both feasible and useful. The team was able to create models using a flexible material that precisely demonstrates target cancer lesions in 3-dimensional space. This helps to characterize the lesions with respect to the location in the prostate, the location relative to the prostate capsule, and the location relative to the neurovascular bundles (NVBs).
Having a good 3D knowledge of these relationships can obviously make a huge difference during prostate surgery. It can help a surgeon know where to absolutely avoid a capsulotomy and where to take wider dissection planes, for example, in order to minimize risks of positive margins and to maximize the preservation of NVBs.
This technology will really be useful for the field of focal therapy, as the models can be useful for research purposes as well as for patient-specific planning of needle placement for ablation probes, for example. However, prostate cancer does not always present in “index lesions,” and clinicians should be mindful that these models are built off of imaging patterns from mpMRI and can miss more diffuse carcinoma throughout the prostate. Thus, one should exercise appropriate caution, as usual, when using these models for surgical planning.
This is a very interesting new technology that can revolutionize the way future surgeons plan surgeries, as long as the 3D printing technology becomes more available and cost-effective. As an added bonus, it can also help with surgical instruction/resident teaching. Lastly, it can be used for counseling patients about their surgery in a way that has never before been possible!
Presented by: Osamu Ukimura, MD, PhD, Kyoto, Japan
Written by: Shreyas Joshi, MD, Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark.