Presented by: Arun Rai MD, MBA, MSc
Northwell Health

Introduction

Preserving neurovascular bundle (NVB) perfusion is been previously identified as an important factor in preserving erectile function and urinary continence after prostatectomy. Most current approaches for visualizing blood flow/perfusion in real-time are: suboptimal (lack objectivity), cumbersome (need for reagent preparation and injection), and lack cost-effective utility (need for large capital equipment). An optical imaging technique based on monochromatic coherent light known as Laser-Speckle-Contrast-Imaging (LSCI) represents a label-free imaging method using coherent monochromatic light where blood flow and tissue perfusion can be detected. We present our initial multi-center experience and feasibility with utilizing this novel technology to identify NVB during robotic assisted laparoscopic radical prostatectomy (RALP).

Materials

RALP was performed in surgeon’s respective institutions (Global Robotics Institute, FL and Northwell Health, NY) with either multiport (Da Vinci Xi) or single port (Da Vinci SP) robotic equipment.  ActivSurgical™’s ActivSight, is a laser speckle based endoscopic imaging module that is positioned between the endoscopic lens and the camera and has the ability to visualize real-time perfusion. During RALP, an accessory port was utilized through which a 10mm laparoscopic lens with the ActivSight module attached was inserted at key points throughout the case via assistant.

Results

,

In both antegrade and retrograde nerve dissection, ActivSight was able to visualize NVB and demonstrate perfusion through dissection. Surgeons did not express any significant workflow alterations or difficulty with using ActivSight during dissection.

Conclusion

This is the first clinical experience to our knowledge describing laser speckle imaging during RALP. ActivSight’s LSCI module was able to offer even highly-experienced surgeons the ability to identify and aid in the preservation of NVB. While information presented here demonstrates some early potential promise, further research and development will be required to validate utility. Once validated, this technology holds the promise of potentially improving surgical “trifecta” outcomes in more patients through NVB preservation.

Funding

None

Co-Authors

Lee Richstone, MD, FRCS
Northwell Health

Louis Kavoussi, MD, MBA
Northwell Health

Nicholas Kavoussi, MD
Vanderbilt University

Manish Vira, MD
Northwell Health

Jay Bishoff, MD
Northwell Health

Vip Patel, MD
Advent Health