Natural Orifice Transluminal Endoscopic Partial Prostatectomy

A Real-time Image-guided Focal Extirpative Feasibility Study

Haidar M. Abdul-Muhsin, Nicholas J. Jakob, Akira Kawashima, Alvin C Silva, Melisa L. Stanton, Gianni Moshero, Erik P Castle, Paul E. Andrews, Mitchell R Humphreys

Research output: Contribution to journalArticle

Abstract

Objective: To assess the feasibility of focal endoscopic excision of prostate cancer (PCa) under guidance of real-time magnetic resonance imaging (MRI) or magnetic ultrasound fusion (MUF). Materials and Methods: Using a cadaveric model, multifocal PCa was simulated using 2 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 in the left transitional zone (ROI 2-suspicious for benign prostatic hyperplasia 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 histopathologic 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 postprocedure MRI confirmed the completeness of resection. Pathologic 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 histopathologic margin status determination possible.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - 2017

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Feasibility Studies
Prostatectomy
Magnetic Resonance Imaging
Prostatic Neoplasms
Ultrasonography
Fiducial Markers
Seminal Vesicles
Solid-State Lasers
Prostatic Hyperplasia
Cadaver
Capsules
Prostate
Lasers
Biopsy

ASJC Scopus subject areas

  • Urology

Cite this

Natural Orifice Transluminal Endoscopic Partial Prostatectomy : A Real-time Image-guided Focal Extirpative Feasibility Study. / Abdul-Muhsin, Haidar M.; Jakob, Nicholas J.; Kawashima, Akira; Silva, Alvin C; Stanton, Melisa L.; Moshero, Gianni; Castle, Erik P; Andrews, Paul E.; Humphreys, Mitchell R.

In: Urology, 2017.

Research output: Contribution to journalArticle

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title = "Natural Orifice Transluminal Endoscopic Partial Prostatectomy: A Real-time Image-guided Focal Extirpative Feasibility Study",
abstract = "Objective: To assess the feasibility of focal endoscopic excision of prostate cancer (PCa) under guidance of real-time magnetic resonance imaging (MRI) or magnetic ultrasound fusion (MUF). Materials and Methods: Using a cadaveric model, multifocal PCa was simulated using 2 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 in the left transitional zone (ROI 2-suspicious for benign prostatic hyperplasia 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 histopathologic 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 postprocedure MRI confirmed the completeness of resection. Pathologic 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 histopathologic margin status determination possible.",
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T1 - Natural Orifice Transluminal Endoscopic Partial Prostatectomy

T2 - A Real-time Image-guided Focal Extirpative Feasibility Study

AU - Abdul-Muhsin, Haidar M.

AU - Jakob, Nicholas J.

AU - Kawashima, Akira

AU - Silva, Alvin C

AU - Stanton, Melisa L.

AU - Moshero, Gianni

AU - Castle, Erik P

AU - Andrews, Paul E.

AU - Humphreys, Mitchell R

PY - 2017

Y1 - 2017

N2 - Objective: To assess the feasibility of focal endoscopic excision of prostate cancer (PCa) under guidance of real-time magnetic resonance imaging (MRI) or magnetic ultrasound fusion (MUF). Materials and Methods: Using a cadaveric model, multifocal PCa was simulated using 2 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 in the left transitional zone (ROI 2-suspicious for benign prostatic hyperplasia 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 histopathologic 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 postprocedure MRI confirmed the completeness of resection. Pathologic 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 histopathologic margin status determination possible.

AB - Objective: To assess the feasibility of focal endoscopic excision of prostate cancer (PCa) under guidance of real-time magnetic resonance imaging (MRI) or magnetic ultrasound fusion (MUF). Materials and Methods: Using a cadaveric model, multifocal PCa was simulated using 2 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 in the left transitional zone (ROI 2-suspicious for benign prostatic hyperplasia 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 histopathologic 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 postprocedure MRI confirmed the completeness of resection. Pathologic 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 histopathologic margin status determination possible.

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