Natural Orifice Transluminal Endoscopic Partial Prostatectomy: a Real Time Image Guided Focal Extirpative Feasibility Study

• Published in: Urology (Ridgewood, N.J.) N.J.), 2017-09, Vol.107, p.262-266
• Main Authors: Abdul-Muhsin, Haidar M., M.B.Ch.B, Jakob, Nicholas J, Kawashima, Akira, M.D., Ph.D., R-D, Silva, Alvin C., M.D.R-D, Stanton, Melisa L., M.D, Moshero, Gianni, P.A.-C, Castle, Erik P., M.D, Andrews, Paul E., M.D, Humphreys, Mitchell R., M.D
• Format: Article
• Language: English
• Subjects: Aged; Cadaver; Endosonography - methods; Feasibility Studies; Humans; Image-Guided Biopsy; Imaging, Three-Dimensional - methods; Magnetic Resonance Imaging - methods; Male; Natural Orifice Endoscopic Surgery - methods; Prostate - diagnostic imaging; Prostate - surgery; Prostatectomy - methods; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - surgery; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2017.05.024

Abstract Objective To assess the feasibility of focal endoscopic excision of PCa under guidance of real time magnetic resonance imaging/ultrasound fusion (MUF). Methods Using a cadaveric model, multi-focal PCa was simulated using two MRI-compatible fiducial markers.These were inserted transrectally and used to generate regions of interests (ROIs) on a 1.5 T surface coil MRI. The first marker was placed in the right mid peripheral zone (ROI 1) and the second marker was placed in the left seminal vesicle as a referent lesion for subsequent imaging. MRI of the specimen was then obtained. The radiologist created ROIs using fusion biopsy system at each marker. Two additional incidental ROIs were identified on the left transitional zone (ROI 2 - suspicious for BPH nodule) and in the right anterior peripheral zone (ROI 3-suspicious for PCa). Holmium Laser enucleation of the transitional zone of the prostate was performed to gain access to the peripheral zone lesions. MUF was used during endoscopic laser excision to convey targeting accuracy. The cadaver was then reimaged to determine the adequacy of resection and examined for histopathological correlation Results Real time MUF imaging identified the target lesions consistently at the locations designated as ROIs. Complete endoscopic resection of ROIs was possible. Repeated MUF imaging and the post procedure MRI confirmed the completeness of resection. Pathological examination demonstrated complete excision, intact neurovascular bundles and posterior prostatic capsule. Conclusion This approach may represent a new minimally invasive frontier for focal surgical resection of PCa making histopathological margin status determination possible.