Methods and Maneuvers for Improving Functional Outcomes During Robotic Radical Prostatectomy

Tan, Gerald; Dorsey, Philip; Tewari, Ashutosh

doi:10.1007/978-1-60761-676-4_18

Cited by 1 publication

(2 citation statements)

References 117 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients receiving radical prostatectomy, the dissection of the bladder neck, mobilization of the neurovascular bundles (NVBs), and transection of the urethra–external sphincter complex, cause primary acute traumatic injury. The tissue damage is associated with the direct mechanical trauma of dissection, traction, as well as thermal energy that leads to neurapraxia or axonotmesis of pelvic autonomic nerves and muscle degeneration [3, 4]. The tissue inflammation may lead to the secondary wave of damage.…”

Section: Introductionmentioning

confidence: 99%

“…It has also been established that cooling using endorectal cooling balloon (ECB) can significantly reduce the recovery time to regain urinary continence and sexual function in men [1, 2, 4, 17], presumably due to the profound effects in reducing an array of tissue damage coming from the direct trauma and the inflammatory reaction [11]. The ECB was fabricated using a 5" × 2.5" elliptical balloon fused to a 40 cm, 24-french, three-way latex urethral catheter.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Investigation of factors affecting hypothermic pelvic tissue cooling using bio-heat simulation based on MRI-segmented anatomic models

Lin

Fwu

et al. 2015

Computer Methods and Programs in Biomedicine

View full text Add to dashboard Cite

This study applied a simulation method to map the temperature distribution based on magnetic resonance imaging (MRI) of individual patients, and investigated the influence of different pelvic tissue types as well as the choice of thermal property parameters on the efficiency of endorectal cooling balloon (ECB). MR images of four subjects with different prostate sizes and pelvic tissue compositions, including fatty tissue and venous plexus, were analyzed. The MR images acquired using endorectal coil provided a realistic geometry of deformed prostate that resembled the anatomy in the presence of ECB. A single slice with the largest two-dimensional (2D) cross-sectional area of the prostate gland was selected for analysis. The rectal wall, prostate gland, peri-rectal fatty tissue, peri-prostatic fatty tissue, peri-prostatic venous plexus, and urinary bladder were manually segmented. Pennes’ bioheat thermal model was used to simulate the temperature distribution dynamics, by using an in-house finite element mesh based solver written in Matlab. The results showed that prostate size and periprostatic venous plexus were two major factors affecting ECB cooling efficiency. For cases with negligible amount of venous plexus and small prostate, the averaged temperature in the prostate and neurovascular bundles could be cooled down to 25°C within 30 minutes. For cases with abundant venous plexus and large prostate, the temperature could not reach 25°C at the end of 3 hours cooling. Large prostate made the cooling difficult to propagate through. The impact of fatty tissue on cooling effect was small. The filling of bladder with warm urine during the ECB cooling procedure did not affect the temperature in the prostate or NVB. In addition to the 2D simulation, in one case a 3D pelvic model was constructed for volumetric simulation. It was found that the 2D slice with the largest cross-sectional area of prostate had the most abundant venous plexus, and was the most difficult slice to cool, thus it may provide a conservative prediction of the cooling effect. This feasibility study demonstrated that the simulation tool could potentially be used for adjusting the setting of ECB for individual patients during hypothermic radical prostatectomy. Further studies using MR thermometry are required to validate the in silico results obtained using simulation.

show abstract

Section: Introductionmentioning

confidence: 99%