Complementary routes towards precision urologic surgery: image guidance technologies and standardized training programmes
Abstract
The studies presented in this thesis focus on the introduction in urology of novel imaging technologies that allow surgical guidance and on the need for standardized, quality assured, certified training pathways in robotic surgery in order to achieve higher level of precision urologic procedures and guarantee patients’ safety.
In the first part of this thesis we demonstrated that:
- SPECT/CT and ICG-99mTc-nanocolloid represent a valid optional dynamic sentinel node biopsy protocol for penile cancer patients candidate to dynamic sentinel node biopsy;
- A novel hybrid radioactive tracer (i.e. 99mTc-EuK-(SO3)Cy5-mas3) provides adeguate fluorescence imaging for intraoperative guidance during prostate cancer surgery; - Sentinel node biopsy with ICG-99mTc-nanocolloid should always be combined with extended pelvic lymph node dissection to improve detection of positive nodes and potentially reduce the risk of recurrence in surgically treated prostate cancer patients; - The application of a robotic-tailored radioguidance modalities (i.e. DROP-IN gamma probe) in prostate cancer surgery helps to extend the pelvic lymph node dissection template in a personalised manner, enables more efficient intraoperative identification of sentinel nodes and when combined with fluorescence imaging allows for a complementary optical confirmation of node localisations. The second part of this thesis focused on the need for standardized, validated training programmes in robotic surgery in order to achieve higher level of precision urologic procedures, to guide surgeons during the learning process of a specific robotic procedure and protect patients from suboptimal outcomes. The available evidence on the disposable standardized and validated robotic training curricula was presented and the first structured training program for robot-assisted radical cystectomy with intracorporeal ileal conduit in male patients was developed.
