Effect of bony pelvic dimensions measured by preoperative magnetic resonance imaging on performing robot‐assisted laparoscopic prostatectomy

Hong, Sung Kyu; Lee, Seung Tae; Kim, Sung Soo; Min, Kyung Eun; Hwang, In Sik; Kim, Myung; Jeong, Seong Jin; Byun, Seok‐Soo; Hwang, Sung Il; Lee, Sang Eun

doi:10.1111/j.1464-410x.2009.08624.x

Cited by 35 publications

(38 citation statements)

References 25 publications

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“…Hong et al, using anatomical parameters obtained from MRI, reported that the working space for robotic arms in the pelvic cavity can be estimated using the PCI. 4 Although no other pelvic dimensions, including the PCI, were found to be associated with operative duration in their study, Mason et al reported that a higher PV-to-PCI ratio was associated with a longer operative time and higher EBL, suggesting that patients with deeper pelvises and larger prostates would be predicted to have more difficulty in RARP procedures. 5 Our analyses also showed that the PV-to-PCI ratio was a significant predictor of console time and EBL using linear regression analysis.…”

Section: Discussionmentioning

confidence: 72%

“…In particular, the PCI represents the working space for the robotic arms within the pelvic cavity. 4 We also measured the PTD, PAD and PCD, which we used to calculate PV using the ellipsoid formula:…”

Section: Mri Measurementsmentioning

confidence: 99%

“…[2][3][4][5] Apart from the study by Nam et al, 2 which showed longer operative time with increased pelvic depth during extraperitoneal laparoscopic prostatectomy, the other the studies did not show any significant correlation between pelvic dimensions and operative time. [3][4][5] Conversely, all four studies showed a positive correlation between increased prostate volumes (PV) and operative time. [2][3][4][5] The concept of pelvic capacity index (PCI) as a measure of pelvic working space used in this study is not new, and had been described in previous studies.…”

Section: Editorial Commentmentioning

confidence: 99%

“…[3][4][5] Conversely, all four studies showed a positive correlation between increased prostate volumes (PV) and operative time. [2][3][4][5] The concept of pelvic capacity index (PCI) as a measure of pelvic working space used in this study is not new, and had been described in previous studies. 3,5 None of these two previous studies, including this present study, reported any significant correlation between PCI and operative time.…”

Section: Editorial Commentmentioning

confidence: 99%

“…The PCI is a representation of the pelvic cavity space that can be accessed by the robotic arms. 4 Furthermore, higher PV-to-PCI ratios have been associated with longer operative times.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical dimensions using preoperative magnetic resonance imaging: Impact on the learning curve of robot‐assisted laparoscopic prostatectomy

et al. 2014

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Abbreviations & Acronyms API = anteroposterior diameter of the pelvic inlet APM = anteroposterior distance at the midpelvis APO = pelvic outlet BMI = body mass index EBL = estimated blood loss ISD = interspinous distance ITD = intertuberous distance MRI = magnetic resonance imaging PCI = pelvic cavity index PD = pelvic depth PSA = prostate-specific antigen PV = prostate volume RARP = robot-assisted laparoscopic prostatectomy Objective: To evaluate the impact of anatomical dimensions as measured using preoperative magnetic resonance imaging on the outcomes of robot-assisted laparoscopic prostatectomy. Methods: We retrospectively reviewed 100 consecutive robot-assisted laparoscopic prostatectomy procedures that were carried out by a single surgeon at the Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan. Preoperative clinical data and anatomical measurements, including the calculated prostate volume pelvic cavity index, were determined based on preoperative magnetic resonance imaging, and their effects on console time, estimated blood loss and surgical margin status were compared. Results: Body mass index, the prostate anteroposterior diameter, and the prostate volume-to-pelvic cavity index ratio were all significantly correlated with console time and estimated blood loss, based on a univariate analysis (P < 0.05). The prostate craniocaudal diameter, prostate transverse diameter and prostate volume also correlated with console time. However, based on the multiple linear regression analysis, only the prostate volumeto-pelvic cavity index ratio was found to be a significant predictor of console time and estimated blood loss. Furthermore, when the 100 total cases were divided into 50 early cases and 50 late cases, the prostate volume-to-pelvic cavity index ratio correlated with console time and estimated blood loss only in the early group, and not in the late group. In contrast, anatomical measurements had no significant effect on surgical margin status. Conclusion: Magnetic resonance imaging can be a valuable adjunct to robot-assisted laparoscopic prostatectomy. Our data show that patients with larger prostates and narrow, deep pelvises might present more difficulty in robot-assisted laparoscopic prostatectomy procedures. However, the present data also show that this problem can be overcome by an experienced operator with improved surgical techniques.

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Section: Discussionmentioning

confidence: 72%

Section: Mri Measurementsmentioning

confidence: 99%

Section: Editorial Commentmentioning

confidence: 99%

Section: Editorial Commentmentioning

confidence: 99%

“…The PCI is a representation of the pelvic cavity space that can be accessed by the robotic arms. 4 Furthermore, higher PV-to-PCI ratios have been associated with longer operative times.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical dimensions using preoperative magnetic resonance imaging: Impact on the learning curve of robot‐assisted laparoscopic prostatectomy

et al. 2014

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Developmental origins of variability in pelvic dimensions: Evidence from nulliparous South Asian women in the United Kingdom

Shirley

Cole

Arthurs

et al. 2019

American J Hum Biol

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Objectives Pelvic growth may be sensitive to early‐life nutrition, with implications for maternal risk of obstructed labor. However, the “developmental origins” of adult pelvic variability require further investigation. We tested whether adult pelvic dimensions are associated with two components of height, indexing different periods of linear growth: tibia length, a proxy for early postnatal growth, and height‐residual (height regressed on tibia length), a proxy for later growth. We also tested whether adult pelvic dimensions are associated with birth weight, a marker of nutritional investment in utero. Methods In this cross‐sectional study, data were obtained on 68 nulliparous young women of South Asian ancestry. Pelvic dimensions (bi‐iliac and bi‐acetabular breadth, anteroposterior pelvic inlet and outlet, interspinous and intertuberous diameter) were measured using magnetic resonance imaging. Height and tibia length were measured manually. Birth weight and gestational age were obtained by recall. Multivariable regression models were fitted with a given pelvic dimension regressed on height‐residual, tibia, and birth weight, with the latter adjusted for gestational age. Results Controlling for birth weight, height‐residual was predictive of bi‐acetabular breadth, bi‐iliac breadth, and the pelvic inlet, while tibia length significantly predicted all dimensions except interspinous diameter. Controlling for the linear growth variables, birth weight was predictive of bi‐iliac breadth only. Conclusions Markers of linear growth during both early and later development were associated with adult pelvic dimensions, whereas size at birth was poorly predictive. Efforts to reduce stunting in early life may facilitate the attainment of maximum potential growth for both height and the pelvis.

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Increased body mass index is associated with operative difficulty during robot‐assisted radical prostatectomy

et al. 2021

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Objective: This study aimed to identify factors associated with surgeon perception of robot-assisted radical prostatectomy (RARP) difficulty.Patients and Methods: This study surveyed surgeons performing RARP between 2017 and 2018 and asked them to rate operative conditions and difficulty as optimal, good, acceptable, or poor. These answers were stratified as optimal or suboptimal for this study. Associations between surgeon responses and variables hypothesized to affect surgical difficulty, including anatomic factors such as pelvic diameter and prostate volume:pelvic diameter ratio, were assessed.Results: Between November 2017 and September 2018, a total of 100 patients were prospectively enrolled in the study of which 58 cases were rated as optimal and 42 were rated as suboptimal. Of the evaluated variables, only increasing clinical T stage (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.03-2.15, p = 0.03) and increasing body mass index (BMI) (OR 1.14, 95% CI 1.03-1.26, p = 0.01) were associated with increased difficulty; 90-day complication rates were similar between the optimal and suboptimal cohorts (17.3% vs. 23.8%, respectively; p = 0.5). The number of patients with previous surgery, pelvic diameter, and prostate size:pelvic diameter ratio were not significantly different between cohorts (p > 0.05 for all). Operative time (ρ = 0.23, p = 0.02) and estimated blood loss (EBL) (ρ = 0.38, p = 0.0001) were correlated with suboptimal difficulty. Conclusion:The factors associated with surgeon-reported RARP difficulty were patient BMI and clinical T stage among surgeons with significant RARP experience. These data should be incorporated into surgical decision making and patient counseling prior to performing a RARP.

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Effect of bony pelvic dimensions measured by preoperative magnetic resonance imaging on performing robot‐assisted laparoscopic prostatectomy

Cited by 35 publications

References 25 publications

Anatomical dimensions using preoperative magnetic resonance imaging: Impact on the learning curve of robot‐assisted laparoscopic prostatectomy

Anatomical dimensions using preoperative magnetic resonance imaging: Impact on the learning curve of robot‐assisted laparoscopic prostatectomy

Developmental origins of variability in pelvic dimensions: Evidence from nulliparous South Asian women in the United Kingdom

Increased body mass index is associated with operative difficulty during robot‐assisted radical prostatectomy

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