Language：Japanese   Publisher：The Japan Society of Computer Aided Surgery  

DOI： 10.5759/jscas.26.276

CiNii Research

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Proton pump inhibitors (PPIs) are widely used due to their affordability and minimal severe side effects. However, their influence on the efficacy of cancer treatments, particularly androgen receptor signaling inhibitors (ARSIs), remains unclear. This study investigates the impact of PPI usage on the treatment outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS: A total of 117 mCRPC patients were retrospectively analyzed and divided into two groups based on the concomitant use of PPI at the initiation of ARSI treatment: PPI+ (n = 38) and PPI- (n = 79). Patient characteristics, including age at ARSI treatment administered, prostate-specific antigen (PSA) value at ARSI treatment administered, International Society of Urological Pathology grade group at prostate biopsy, metastatic site at ARSI treatment administered, prior docetaxel (DTX) treatment, and type of ARSI (abiraterone acetate or enzalutamide) were recorded. Progression-free survival (PFS), overall survival (OS), and PSA response rates were compared between the two groups. Patients were further stratified by clinical background to compare PFS and OS between the two groups. RESULTS: The PPI- group exhibited significantly extended PFS and a trend toward improved OS. For PSA response (reduction of 50% or more from baseline), the rates were 62.3% and 45.9% in the PPI- group and the PPI+ group, respectively. For deep PSA response (reductions of 90% or more from baseline), the rates were 36.4% and 24.3% in the PPI- group and the PPI+ group, respectively. The effects were consistent across subgroups divided by prior DTX treatment and type of ARSI administered. CONCLUSIONS: The administration of PPIs appears to diminish the therapeutic efficacy of ARSIs in mCRPC patients. Further prospective studies are needed to confirm these findings and explore the biological mechanisms involved.

DOI： 10.1002/pros.24769

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BACKGROUND: This study aimed to show the association between tumor location and laterality of positive lymph nodes by evaluating biopsy and magnetic resonance imaging (MRI) findings, and to optimize the extended pelvic lymph node dissection (ePLND) side for prostate cancer. METHODS: The study enrolled patients who underwent robot-assisted radical prostatectomy with ePLND. Tumor locations were determined according to International Society of Urological Pathology grade group 4/5 in biopsies and Prostate Imaging-Reporting and Data System category 4/5 in MRI results. The concordance of tumor location lobe and positive lymph node side with the performance of tumor location-guided ePLND for positive lymph node detection was evaluated. RESULTS: For 301 patients who underwent ePLND at Kyushu University Hospital, tumor locations determined by biopsy and MRI findings showed no lesion in 8 (2.7%) patients, unilateral lobe in 223 (74.1%) patients, and bilateral lobe in 70 (23.3%) patients. The accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were 99.6% and 97.3%, respectively. Among the patients at St. Luke's International Hospital, the accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were estimated to be 99.0% and 97.3%, respectively. CONCLUSIONS: This study proposed tumor location-guided ePLND according to biopsy and MRI findings. This novel strategy is expected to reduce the burden of bilateral ePLND at the cost of acceptable risk of failing to detect positive lymph nodes.

DOI： 10.1245/s10434-024-16294-6

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Androgen receptor (AR)-targeting therapy induces oxidative stress in prostate cancer. However, the mechanism of oxidative stress induction by AR-targeting therapy remains unclear. This study investigated the mechanism of oxidative stress induction by AR-targeting therapy, with the aim to develop novel therapeutics targeting oxidative stress induced by AR-targeting therapy. Intracellular reactive oxygen species (ROS) was examined by fluorescence microscopy and flow cytometry analysis. The effects of silencing gene expression and small molecule inhibitors on gene expression and cytotoxic effects were examined by quantitative real-time PCR and cell proliferation assay. ROS induced by androgen depletion co-localized with peroxisomes in prostate cancer cells. Among peroxisome-related genes, PPARA was commonly induced by AR inhibition and involved in ROS production via PKC signaling. Inhibition of PPARα by specific siRNA and a small molecule inhibitor suppressed cell proliferation and increased cellular sensitivity to the antiandrogen enzalutamide in prostate cancer cells. This study revealed a novel pathway by which AR inhibition induced intracellular ROS mainly in peroxisomes through PPARα activation in prostate cancer. This pathway is a promising target for the development of novel therapeutics for prostate cancer in combination with AR-targeting therapy such as antiandrogen enzalutamide.

DOI： 10.1016/j.freeradbiomed.2024.05.030

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Robotic Surgery  

Our objective was to investigate the long-term functional outcomes of robot-assisted partial nephrectomy (RAPN) combined with three-dimensional (3D) imaging. The 3D images, reconstructed using computed tomography, were introduced in RAPN procedures. The demographic, oncological, functional, and volumetric outcomes of 296 patients who underwent RAPN with and without 3D imaging between 2013 and 2021 were analyzed retrospectively. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. After matching, 71 patients were allocated to each group. In the 3D RAPN (3DRPN) group, functional outcomes significantly improved: the number of patients with over 90% estimated glomerular filtration rate (eGFR) preservation rate (40 vs. 43, P = 0.044), eGFR preservation rate (88.0% vs. 91.6%, P = 0.006), the number of patients with chronic kidney disease (CKD) upstaging (26 vs. 13, P = 0.023), and split renal function preservation rate (operated kidney: 84.9% vs. 88.5%, P = 0.015). The 3DRPN group showed superiority in terms of >90% eGFR preservation (P = 0.010), CKD upstaging-free survival rates (P < 0.001), and volumetric outcomes (excess parenchymal volume: 27.9 vs. 17.7 mL, P = 0.030; parenchyma volume preservation rate: 81.6% vs. 88.8%, P = 0.006). Three-dimensional imaging was positively associated with eGFR preservation (P = 0.023, odds ratio: 2.34) and prevention of CKD upstaging (P = 0.013, odds ratio: 2.90). In this study, RAPN combined with 3D imaging underscored the preservation of eGFR > 90% and the prevention of CKD upstaging by improving the preservation rate of renal parenchyma and split renal function.

DOI： 10.1007/s11701-024-02070-x

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In the last decade, the standard treatment for advanced renal cell carcinoma (RCC) has evolved, mainly driven by the development and approval of immune checkpoint inhibitors (ICIs). Currently, ICI monotherapy and ICI-based combinations with tyrosine kinase inhibitors and targeted therapies against mammalian target of rapamycin or vascular endothelial growth factor have become new standard treatments for first-line and subsequent-line therapies. ICIs play an important role as an adjuvant postoperative therapy, and this field is the subject of active research. Furthermore, ongoing randomized controlled trials are investigating the clinical value of more intense treatments by combining multiple effective treatments for RCC. Additionally, novel biomarkers for prognosis have been investigated. This study reviews the current evidence on immunotherapy as a treatment for RCC patients, randomized controlled trials, and ongoing studies including RCC patients and recent findings, and discusses future perspectives.

DOI： 10.1007/s10147-023-02446-3

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Androgen receptor signaling is crucial for the development of treatment resistance in prostate cancer. Among steroidogenic enzymes, 3β-hydroxysteroid dehydrogenases (3βHSDs) play critical roles in extragonadal androgen synthesis, especially 3βHSD1. Increased expression of 3βHSDs is observed in castration-resistant prostate cancer tumors compared with primary prostate tumors, indicating their involvement in castration resistance. Recent studies link 3βHSD1 to resistance to androgen receptor signaling inhibitors. The regulation of 3βHSD1 expression involves various factors, including transcription factors, microenvironmental influences, and post-transcriptional modifications. Additionally, the clinical significance of HSD3B1 genotypes, particularly the rs1047303 variant has been extensively studied. The impact of HSD3B1 genotypes on treatment outcomes varies according to the therapy administered, suggesting the potential of HSD3B1 genotyping for personalized medicine. Targeting 3βHSDs may be a promising strategy for prostate cancer management. Overall, understanding the roles of 3βHSDs and their genetic variations may enable the development and optimization of novel treatments for prostate cancer.

DOI： 10.1530/ERC-24-0023

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DOI： 10.1111/iju.15449

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

転移性去勢抵抗性前立腺癌(mCRPC)に対するカバジタキセル後の治療パターンを評価し、生存への影響について検討した。2014～2023年にカバジタキセルによる治療を受けたmCRPC日本人患者を対象とした。全生存期間はカバジタキセル最終投与から死亡または最終追跡時点までとし、カプランマイヤー法により推定した。患者36例(カバジタキセル開始時、中央値72.5歳)を解析した。多くの患者がカバジタキセル治療前にアンドロゲン受容体シグナル伝達阻害薬(ARSI)やドセタキセルによる治療を受けた。36例中11例がカバジタキセル後に別の薬物治療を受けた。カバジタキセル後の追跡期間中央値4.27ヵ月に、33例(91.7%)が死亡した。12ヵ月全生存率は、カバジタキセル後に治療を受けた群で25.3%(95%CI:4.1～55.5)、受けなかった群で8%(同1.4～2.2)であった(p=0.0499)。カバジタキセル後に一次治療ARSI、オラパリブ、ラジウム223、またはドセタキセルを受けた患者と受けなかった患者の12ヵ月全生存率はそれぞれ50.0%(同11.1～80.4)と7%(同1.2～20.1)であった(p=0.0231)。以上より、mCRPCにおいてカバジタキセル後に治療を受けた患者では受けなかった患者よりも全生存期間が長いことが示された。

Language：English   Publishing type：Research paper (scientific journal)  

Background: Early detection of biochemical recurrence (BCR) after radical prostatectomy (RP) is crucial for early treatment and improving survival outcomes. The optimal prostate-specific antigen (PSA) monitoring remains unclear, and several models have been proposed. We aimed to externally validate four models for optimal PSA monitoring after RP and propose modifications to improve them. Methods: We reviewed the clinicopathological data of 896 patients who underwent robot-assisted RP between 2009 and 2022. We examined all PSA values and estimated the PSA value for four monitoring schedules at each time point in the virtual follow-up. We defined the ideal PSA for BCR detection between 0.2 and 0.4 ng/mL. Results: During the median follow-up of 21.4 months, 128 (14.3%) patients presented BCR. The original and modified Keio models, National Cancer Center Hospital model, and American Urological Association/American Society for Radiation Oncology model detected BCR in 14 (10.9%), three (2.3%), 12 (9.4%), and 11 (8.6%) patients with PSA >0.4 ng/mL. Most patients experienced BCR detected with PSA >0.4 ng/mL during the first year postoperative. The modification of interval within 6 months postoperative avoided BCR detection with PSA >0.4 ng/mL within the first year postoperative in 8/9 (88.9%), 1/2 (50.0%), 5/6 (83.3%), and 4/4 (100%) for the original and modified Keio models, National Cancer Center Hospital model, and American Urological Association/American Society for Radiation Oncology model, respectively. Conclusion: We validated four models for PSA monitoring after RP to detect BCR and suggested modifications to avoid detections out of the desired range of PSA. These modifications could help to establish an optimal PSA monitoring schedule after RP.

DOI： 10.1111/iju.15379

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根治的前立腺摘除術(RP)後に行う前立腺特異抗原(PSA)モニタリングの4つのモデルの妥当性を検証し、生化学的再発(BCR)検出を改善する修正モデルを検討した。2009～2022年にロボット支援RPを受けた患者の臨床病理学的データを調べ、4つのモデルで仮想上経過観察時のPSA値を推定した。BCR検出に最適なPSA値は0.2～0.4ng/mLと定義した。患者896例(年齢中央値66歳)を解析した。追跡期間中央値21.4ヵ月の間に128例(14.3%)がBCRを認めた。BCRが検出されたPSA値0.4ng/mL超の患者は、慶應モデル、修正慶應モデル、国立がん研究センター中央病院(NCCH)モデル、および米国泌尿器科学会(AUA)/米国放射線腫瘍学会(ASTRO)モデルでそれぞれ14例(10.9%)、3例(2.3%)、12例(9.4%)、および11例(8.6%)であった。殆どの患者は、術後1年目にPSA値0.4ng/mL超でBCRが検出された。術後6ヵ月以内の間隔に変更すると、術後1年以内のPSA>0.4ng/mLのBCR検出は上記のモデルそれぞれで8/9例(88.9%)、1/2例(50.0%)、5/6(83.3%)、4/4例(100%)で回避された。以上より、RP後のBCR検出のためのPSAモニタリングを最適にするための修正案が示唆された。

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PURPOSE: This study presents the surgical and oncological outcomes of salvage robot-assisted radical prostatectomy (RARP) after carbon ion radiotherapy at a single institution. METHODS: Patients who underwent salvage RARP for local recurrence after carbon ion radiotherapy at Kyushu University Hospital between 2020 and 2023 were included. A single surgeon performed salvage RARP with extended pelvic lymph node dissection. Clinicopathological characteristics and perioperative and postoperative outcomes were prospectively collected and electronically recorded. RESULTS: Ten cases were included. The preoperative clinical T-stage was T2, except for one case with T3a. The median console time was 171 min (range, 135-226 min). No severe perioperative or postoperative complications were noted. The pathological T-stage was T2, T3a, and T3b in four, four, and two cases, respectively. Biochemical recurrence was observed in one patient at 31.2 months after surgery. For patients with more than 1 year of follow-up, urinary continence recovery with ≤1 pad was achieved in two cases within 1 year, whereas four cases did not recover urinary continence within 1 year. CONCLUSIONS: This case series demonstrated the feasibility of salvage RARP after carbon ion radiotherapy. Although the urinary continence recovery was modest, short-term disease control was favorable.

DOI： 10.1111/ases.13279

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

前立腺癌に対する炭素イオン線治療(CIRT)後のサルベージロボット支援前立腺全摘術(RARP)の手術アウトカムと腫瘍アウトカムについて検討した。2020～2023年に、CIRT後に局所再発をきたしてRARPを施行された前立腺癌患者10例(中央値69歳)を対象とした。拡大骨盤リンパ節郭清(PLND)によるサルベージRARPを行い、臨床病理学的特徴、周術期アウトカムおよび術後アウトカムを評価した。CIRT後の局所再発時のPSA中央値は4.02ng/mL、生検によるGleason分類ではグレードIIが1例、グレードIIIが2例、グレードIVが2例、グレードVが5例であり、術前の臨床的Tステージは9例がT2、1例のみT3a、初期診断から局所再発までは中央値58.5ヵ月であった。RARPに際して全例にPLND、1例に両側神経温存手術を行い、手術時間中央値は235分、コンソール時間中央値は171分、推定出血量中央値は150mLであった。直腸損傷といった周術期合併症や術後90日以内の再入院、尿道狭窄は認められなかった。腫瘍アウトカムに関して、1例が術後31.2ヵ月に生化学的再発を呈した。CIRT後に局所再発をきたした前立腺癌患者に対して、RARPは実行可能な手技であることが示された。

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

The novel technique of lateral pelvic fascia preservation (LPFP) in robot-assisted radical prostatectomy (RARP) has been reported to improve urinary continence recovery. We aimed to investigate surgical and oncological outcomes after RARP using the LPFP technique and compare them with conventional RARP. This study included patients who underwent RARP with and without the LPFP technique. Time to urinary continence recovery was compared between the LPFP and non-LPFP groups using univariate, multivariate, and propensity-score matched analysis. Perioperative and postoperative outcomes were compared between the two groups using univariate analysis. We included 139 patients who underwent RARP, 68 in the LPFP group and 71 in the non-LPFP group. The LPFP technique was associated with a shorter time to urinary continence recovery, a shorter operative time and lower estimated blood loss. Surgical and oncological outcomes, including complications, pathological T-stage, surgical margin status, and biochemical recurrence-free survival, were comparable between the two groups. This study demonstrated that the LPFP technique improves urinary continence recovery and operative times without compromising surgical and oncological outcomes. The use of this technique in patients with clinically localized prostate cancer is recommended.

DOI： 10.1007/s11701-023-01702-y

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This study investigated cellular mechanisms in steroidogenesis responsible for treatment resistance to the novel antiandrogen agent darolutamide in prostate cancer. HSD3B1 was overexpressed in darolutamide-resistant cells and induced by darolutamide treatment and AR knockdown. Inversely, HSD3B1 knockdown increased cellular sensitivity to darolutamide. Similarly, its upstream regulator NR5A2 was up-regulated in darolutamide-resistant cells and induced by darolutamide treatment and AR knockdown. Inversely, NR5A2 knockdown and NR5A2 inhibitor ML180 decreased expression of various steroidogenic enzymes including HSD3B1, leading to increased cellular sensitivity to darolutamide. The NR5A2/HSD3B1 pathway promoted cellular resistance to darolutamide and targeting NR5A2/HSD3B1 pathway is a promising therapeutic strategy to overcome darolutamide resistance.

DOI： 10.1016/j.drup.2023.100990

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Our objective was to evaluate the feasibility of a multi-section continuum robotic ureteroscope to address the difficulties with access into certain renal calyces during flexible ureteroscopy. First, the robotic ureteroscope developed in previous research, which utilizes three actuated bendable sections controlled by wires, was modified for use in this project. Second, using phantom models created from five randomly selected computer tomography urograms, the flexible ureteroscope and robotic ureteroscope were evaluated, focusing on several factors: time taken to access each renal calyx, time taken to aim at three targets on each renal calyx, the force generated in the renal pelvic wall associated with ureteroscope manipulation, and the distance and standard deviation between the ureteroscope and the target. As a result, the robotic ureteroscope utilized significantly less force during lower pole calyx access (flexible ureteroscope vs. robotic ureteroscope; 2.0 vs. 0.98 N, p = 0.03). When aiming at targets, the standard deviation of proper target access was smaller for each renal calyx (upper pole: 0.49 vs. 0.11 mm, middle: 0.84 vs. 0.12 mm, lower pole: 3.4 vs. 0.19 mm) in the robotic ureteroscope group, and the distance between the center point of the ureteroscope image and the target was significantly smaller in the robotic ureteroscope group (upper: 0.49 vs. 0.19 mm, p < 0.001, middle: 0.77 vs. 0.17 mm, p < 0.001, lower: 0.77 vs. 0.22 mm, p < 0.001). In conclusion, our robotic ureteroscope demonstrated improved maneuverability and facilitated accuracy and precision while reducing the force on the renal pelvic wall during access into each renal calyx.

DOI： 10.1007/s11701-023-01530-0

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PURPOSE: Understanding the three-dimensional anatomy of percutaneous intervention in prostate cancer is essential to avoid complications. Recently, attempts have been made to use machine learning to automate the segmentation of functional structures such as the prostate gland, rectum, and bladder. However, a paucity of material is available to segment extracapsular structures that are known to cause needle deflection during percutaneous interventions. This research aims to explore the feasibility of the automatic segmentation of prostate and extracapsular structures to predict needle deflection. METHODS: Using pelvic magnetic resonance imagings (MRIs), 3D U-Net was trained and optimized for the prostate and extracapsular structures (bladder, rectum, pubic bone, pelvic diaphragm muscle, bulbospongiosus muscle, bull of the penis, ischiocavernosus muscle, crus of the penis, transverse perineal muscle, obturator internus muscle, and seminal vesicle). The segmentation accuracy was validated by putting intra-procedural MRIs into the 3D U-Net to segment the prostate and extracapsular structures in the image. Then, the segmented structures were used to predict deflected needle path in in-bore MRI-guided biopsy using a model-based approach. RESULTS: The 3D U-Net yielded Dice scores to parenchymal organs (0.61-0.83), such as prostate, bladder, rectum, bulb of the penis, crus of the penis, but lower in muscle structures (0.03-0.31), except and obturator internus muscle (0.71). The 3D U-Net showed higher Dice scores for functional structures ([Formula: see text]0.001) and complication-related structures ([Formula: see text]0.001). The segmentation of extracapsular anatomies helped to predict the deflected needle path in MRI-guided prostate interventions of the prostate with the accuracy of 0.9 to 4.9 mm. CONCLUSION: Our segmentation method using 3D U-Net provided an accurate anatomical understanding of the prostate and extracapsular structures. In addition, our method was suitable for segmenting functional and complication-related structures. Finally, 3D images of the prostate and extracapsular structures could simulate the needle pathway to predict needle deflections.

DOI： 10.1007/s11548-022-02757-2

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BACKGROUND: Early intravesical recurrence after transurethral resection of bladder tumors (TURBT) is often caused by overlooking of tumors during TURBT. Although narrow-band imaging and photodynamic diagnosis were developed to detect more tumors than conventional white-light imaging, the accuracy of these systems has been subjective, along with poor reproducibility due to their dependence on the physician's experience and skills. To create an objective and reproducible diagnosing system, we aimed to assess the utility of artificial intelligence (AI) with Dilated U-Net to reduce the risk of overlooked bladder tumors when compared with the conventional AI system, termed U-Net. MATERIAL AND METHODS: We retrospectively obtained cystoscopic images by converting videos obtained from 120 patients who underwent TURBT into 1,790 cystoscopic images. The Dilated U-Net, which is an extension of the conventional U-Net, analyzed these image datasets. The diagnostic accuracy of the Dilated U-Net and conventional U-Net were compared using the following four measurements: pixel-wise sensitivity (PWSe); pixel-wise specificity (PWSp); pixel-wise positive predictive value (PWPPV), representing the AI diagnostic accuracy per pixel; and dice similarity coefficient (DSC), representing the overlap area between the bladder tumors in the ground truth images and segmentation maps. RESULTS: The cystoscopic images were divided as follows, according to the pathological T-stage: 944, Ta; 412, T1; 329, T2; and 116, carcinoma in-situ. The PWSe, PWSp, PWPPV, and DSC of the Dilated U-Net were 84.9%, 88.5%, 86.7%, and 83.0%, respectively, which had improved when compared to that with the conventional U-Net by 1.7%, 1.3%, 2.1%, and 2.3%, respectively. The DSC values were high for elevated lesions and low for flat lesions for both Dilated and conventional U-Net. CONCLUSIONS: Dilated U-Net, with higher DSC values than conventional U-Net, might reduce the risk of overlooking bladder tumors during cystoscopy and TURBT.

DOI： 10.1089/end.2021.0483

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

ロボット支援腎部分切除術の術中超音波検査は,腎腫瘍を確実に切除するために必須である.術中超音波検査に用いられるL43Kプローブは,この術式に使用される超音波プローブの1つであり,術中はフェネストレイテッド鉗子でプローブのフィンを把持して使用する.RAPNは狭い後腹膜腔で鉗子を使ってプローブを操作しなければならず,プローブ先端からフィンを把持することが頻回にあった.このフィンはプローブ先端に向かって傾斜が低くなりかつ放射状に広がっている構造のため,プローブ先端から把持できない設計になっている.これが原因でプローブ先端からの把持は安定せず,プローブを頻回に落としていた.今回我々はプローブの先端から把持しづらい課題に対して,医工連携を通してプローブアタッチメントを開発して解決したので報告する.(著者抄録)

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OBJECTIVES: To investigate predictive factors of survival of metastatic castration-resistant prostate cancer patients undergoing first-line treatment with androgen receptor pathway inhibitors or docetaxel. METHODS: Japanese patients with metastatic castration-resistant prostate cancer treated with androgen receptor pathway inhibitor or docetaxel between 2008 and 2018 were included. The differential impact of various clinicopathological factors on the outcome, including progression-free survival and overall survival, was compared between treatment with androgen receptor pathway inhibitor and docetaxel. RESULTS: Of 254 patients with metastatic castration-resistant prostate cancer, 119 (46.9%) and 135 (53.2%) were treated with androgen receptor pathway inhibitor and docetaxel, respectively. The multivariate analysis showed that androgen receptor pathway inhibitor was an independent prognostic factor for better progression-free survival (hazard ratio 0.62, 95% confidence interval 0.42-0.92, P = 0.016) and overall survival (hazard ratio 0.61, 95% confidence interval 0.41-0.93, P = 0.021), compared with docetaxel. Pretreatment prostate-specific antigen levels and time to castration-resistant prostate cancer were differentially associated with progression-free survival and overall survival between androgen receptor pathway inhibitor or docetaxel. In patients who presented <6 months to castration-resistant prostate cancer, progression-free survival was shorter in those treated with androgen receptor pathway inhibitor (median 1.1 months, 95% confidence interval 0.2-2.8 months) compared with those who received docetaxel (median 5.0 months, 95% confidence interval 1.8-6.7 months; P = 0.014). CONCLUSIONS: First-line therapy with androgen receptor pathway inhibitor is associated with a better prognosis when compared with docetaxel, even after adjustment for prognostic factors. However, a shorter time to castration-resistant prostate cancer is associated with better progression-free survival for patients receiving docetaxel, suggesting that docetaxel is the preferred option for patients with a shorter time to castration-resistant prostate cancer.

DOI： 10.1111/iju.14702

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There are multiple reports on the value of complete blood count (CBC)-related parameters on prognosis in docetaxel-treated castration-resistant prostate cancer (CRPC) patients before the emergence of androgen receptor pathway inhibitors (ARPIs). We investigated the prognostic significance of CBC-related parameters in docetaxel-treated CRPC patients. Patients treated with docetaxel chemotherapy for CRPC between 2008 and 2018 were included. We analyzed the relevance of CBC-related parameters to oncological prognosis in docetaxel chemotherapy, associated with prior use of novel ARPIs. Among 144 Japanese men treated with docetaxel, 49 men (34.0%) had already received ARPI therapy. A high neutrophil-lymphocyte ratio (NLR) was a prognostic factor for poor progression-free survival and overall survival (OS) in both univariate and multivariate analyses. In addition, a low hemoglobin (Hb) level and a high systemic immune-inflammation index (SII) were prognostic factors of poor OS in univariate analysis. Hb level was a prognostic factor of OS in both ARPI-naive and ARPI-treated patients. However, a high NLR and SII were only associated with a poor prognosis in ARPI-naive but not in ARPI-treated patients. Hb, NLR, and SII have been suggested to be prognosticators in docetaxel-treated CRPC patients. The differential prognostic value of NLR and SII between ARPI-naive and ARPI-treated patients may require caution when using these markers in docetaxel-treated CRPC patients.

DOI： 10.1097/CAD.0000000000001170

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

転移性去勢抵抗性前立腺癌(CRPC)の第一選択治療としてアンドロゲン受容体経路阻害剤(ARPI)やドセタキセルの臨床転帰に関する予測マーカーを検討した。2008年から2018年までにARPIまたはドセタキセルによる治療を受けた転移性CRPCの日本人患者254例(年齢中央値73歳)を対象とした。転移性CRPC患者254例のうち、119例と135例がそれぞれARPIとドセタキセルを受けた。多変量解析の結果、ARPIは、ドセタキセルと比較して、無増悪生存期間(PFS)(ハザード比0.62、95%CI 0.42～0.92、p=0.016)および全生存期間(OS)(ハザード比0.61、95%CI 0.41～0.93、p=0.021のより良い独立した予後因子であった。治療前の前立腺特異抗原レベルとCRPCになるまでの期間は、ARPIとドセタキセルでは、PFSやOSと異なる相関が認められた。CRPCを6ヵ月未満で発症した患者のうち、ARPIを受けた患者のPFS(中央値1.1ヵ月、95%CI 0.2～2.8ヵ月)は、ドセタキセルを受けた患者のPFS(中央値5.0ヵ月、95%CI 1.8～6.7ヵ月、p=0.014)よりも短かった。以上より、ARPIによる一次治療は、予後因子を調整した後でも、ドセタキセルと比較してより良い予後と関連していた。

Publishing type：Research paper (scientific journal)  

35：109-118

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Language：Japanese   Publisher：Japanese Society of Endourology and Robotics  

<p>  Intraoperative laparoscopic ultrasound in robot-assisted partial nephrectomy is essential to reliably remove a renal tumor. The L43K probe used for intraoperative laparoscopic ultrasound is one of the ultrasound probes used in this surgery, and the fins of the probe are grasped with fenestrated forceps during surgery. Surgeons must manipulate the robot in a narrow retroperitoneal cavity and often grip the fins from the probe’s tip. The conventional probe fin toward the probe tip has a structure in which the inclination becomes low grasp is not spread radially, and is designed not to be gripped from the probe tip. Therefore, the unstable while gripping the probe’s tip, and surgeons have frequently dropped the probe. In this study, we propose a solution to resolve this gripping difficulty by developing a probe attachment.</p>

DOI： 10.11302/jserjje.35.1_109

CiNii Research

Language：Japanese   Publisher：Japanese Society of Endourology and Robotics  

<p>　腎腫瘍は局在と形態は多岐にわたり, 腎血管の数と形態にも個体差がある. 従って, ロボット支援腎部分切除術 (robot-assisted partial nephrectomy ; RAPN) では多様な解剖学的特徴を踏まえ手術のアプローチ方法を術前に計画しておく必要がある. この術前計画において, 医療画像から作成された腎癌3D画像は, 腎腫瘍や腎血管の情報を視覚的に理解するのに役立ち, この画像を使った3次元的な解剖理解によって腎動脈の遮断予定部位, 温存可能な血管の確認と腫瘍切除に伴う尿路の損傷範囲を予測することが可能となり, 詳細な術前計画を立てることができる. しかし, 3D画像を生成するためには, 医用画像解析ワークステーションとソフトウエアが必要となり, これらを扱うための専門知識がユーザーには求められる. また, 多様なソフトウエアをクラウドベースまたはサブスクライブされたアプリケーションの中から, ユーザーの用途に合わせて選択しなければならない. そして, ユーザーはソフトウエアを使って腎臓, 腫瘍, 腎血管や尿路をセグメンテーションしてラベルデータを作成し, このデータをレンダリングして3D画像を作成することになる. 従って, ソフトウエアを使った腎癌3D画像の作成は, RAPNのナビゲーションを実施する上で重要でかつ最初のタスクである. しかし, このタスクを遂行する上で, 多くの医療者は医療解析ソフトの特性からその操作方法に至るまでの知識と経験を持ち合わせていない場合があり, 3D画像を使ったRAPNのナビゲーションの導入についてハードルが高く感じていることがある.</p><p>　本稿では, ナビゲーションを実践するために重要な腎癌3D画像の作成について, 最新の知見を含め報告する.</p>

DOI： 10.11302/jserjje.35.2_198

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

2022, 35：1－5.

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Language：English  

DOI： 10.1002/iju5.12349

Language：English   Publishing type：Research paper (scientific journal)  

<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.</jats:p>
</jats:sec>

DOI： 10.1093/bjs/znab101

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Objective</jats:title>
<jats:p>This study aimed to reveal the prognostic values of prior local therapy in first-line therapy using androgen receptor-axis targeting agents (abiraterone or enzalutamide) or docetaxel for castration-resistant prostate cancer (CRPC).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>The study included 303 patients treated with first-line therapy for non-metastatic and metastatic CRPC. The association between prior local therapy and therapeutic outcome including progression-free survival and overall survival was investigated by univariate and multivariate analyses as well as propensity score-matched analysis.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>In univariate analysis, local prior therapy was associated with a lower risk of all-cause mortality (hazard ratio, 0.56, 95% confidence interval, 0.40–0.79; P = 0.0009). Overall survival, but not progression-free survival, was better among patients with prior local therapy compared with patients without prior local therapy even after multivariate analysis and propensity score-matched analysis.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>This study robustly indicated that prior local treatment was prognostic for overall survival among patients with CRPC. This finding is useful to predict patient prognosis in CRPC.</jats:p>
</jats:sec>

DOI： 10.1093/jjco/hyab019

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: This study investigated the prognostic significance of complete blood count data in castration-resistant prostate cancer patients treated using androgen receptor pathway inhibitors (ARPIs). PATIENTS AND METHODS: Patients treated with an ARPI, abiraterone or enzalutamide, as first-line therapy for castration-resistant prostate cancer from 2014 to 2018 were included. The association between complete blood count data and prognoses including progression-free survival and overall survival (OS) was investigated. RESULTS: High white blood cell counts (<median vs. ≥median; hazard ratio [HR], 1.82, 95% confidence interval [CI], 1.14-2.89; P = 0.012) and high neutrophil-to-lymphocyte ratios (<median vs. ≥median; HR, 1.90, 95% CI, 1.11-3.27; P = 0.020) were associated with a high risk of progression in univariate analysis. In univariate analysis, high hemoglobin (Hb) levels (<median vs. ≥median; HR, 0.41, 95% CI, 0.24-0.73; P = 0.0023) and high red cell distribution widths (<median vs. ≥median; HR, 2.41, 95% CI, 1.37-4.25; P = 0.0023) were associated with a low and a high risk of all-cause mortality, respectively. In multivariate analysis, high Hb levels (<median vs. ≥median; HR, 0.42, 95% CI, 0.22-0.79; P = 0.0076) were repeatedly associated with a low risk of all-cause mortality. CONCLUSION: We found that white blood cell counts and neutrophil-to-lymphocyte ratios may be prognostic for progression-free survival while red cell distribution widths may be prognostic for OS. In particular, a low Hb level was a robust prognostic factor for poor OS. These findings could be useful in predicting prognosis in CRPC patients treated with ARPIs.

DOI： 10.1016/j.urolonc.2020.09.036

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To identify predictors of renal function preservation, and to compare the global and split renal function outcomes of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy. METHODS: Demographic, operative and pathological data, as well as renal function outcomes, of 251 patients who underwent laparoscopic (n = 104) and robot-assisted (n = 147) partial nephrectomy between 2008 and 2018 were retrospectively analyzed. Propensity score matching (1:1) was carried out to adjust for potential baseline confounders. Functional outcomes were assessed based on the estimated glomerular filtration rate and dynamic renal scintigraphy (using 99m Tc-mercaptoacetyltriglycine), including renal volumetric analysis. RESULTS: A total of 98 patients were allocated to each partial nephrectomy group. Ischemic (laparoscopic vs robot-assisted partial nephrectomy: 29 vs 15 min, P < 0.001) and operative times (181 vs 100 min, P < 0.001) were shorter in robot-assisted partial nephrectomy. The preservation ratio of global renal function at 3 months (88.3% vs 91.4%, P = 0.040) and 12 months (87.8% vs 91.5%, P = 0.010) postoperatively, and the renal function of the operated kidney (80.3% vs 88.2%, P < 0.001) were greater after robot-assisted partial nephrectomy. In robot-assisted partial nephrectomy, the volume of resected parenchyma was significantly smaller (27.2 vs 15.5 mL, P < 0.001), resulting in greater postoperative normal parenchymal volumes (120 vs 132 mL, P < 0.001) and a greater parenchymal preservation ratio (81.1% vs 90.1%, P < 0.001). The parenchymal preservation ratio was the strongest predictor of renal function preservation after surgery (P < 0.001, odds ratio 6.02). CONCLUSIONS: Robot-assisted partial nephrectomy allows better preservation of split renal function than laparoscopic partial nephrectomy by increasing the parenchymal preservation ratio. This translates into better postoperative global renal function.

DOI： 10.1111/iju.14525

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The aim of this study was to determine the prevalence of collecting system invasion (CSI) on multiphasic CT, validate the pathological findings, and investigate the relationship between CSI and clinical outcomes in patients with renal cell carcinomas (RCC). METHODS: Patients pathologically diagnosed with RCC between January 2008 and December 2017 were retrospectively enrolled in this study. They were divided into two groups according to the presence of CSI on multiphasic CT images. Patients' clinical characteristics, radiological findings, and overall survival (OS) and recurrence-free survival (RFS) rates were analyzed and compared between the groups. In addition, the correlation of radiological findings with pathological findings was investigated. RESULTS: Among the included 347 kidneys of 340 patients, CSI was observed in 11 kidneys (3%; 95% confidence interval, 1.3-5.0%). In all the 11 kidneys, the tumors were pathologically diagnosed as clear cell RCC, and in one kidney, the tumor also had sarcomatoid features. When pathological CSI served as the standard of reference, the sensitivity, specificity, and accuracy of CSI on CT were 50%, 99.7%, and 97.1%, respectively. The OS and RFS rates were not significantly different between patients with CSI on CT and those without CSI. CONCLUSION: This study found that the prevalence of RCC-related CSI was 3%. Because of the low prevalence, we cannot exclude the possibility that CSI on CT would be associated with the OS and RFS. Further studies are needed to determine whether CSI on CT can be an independent prognostic factor for survival in patients with RCC.

DOI： 10.1007/s00261-020-02859-y

Language：English   Publishing type：Research paper (scientific journal)  

Salvage radical prostatectomy is a therapeutic option for the biochemical recurrence of prostate cancer after radiotherapy. However, only one case report of salvage radical prostatectomy after carbon ion radiotherapy has been reported. We report a case of salvage robot-assisted radical prostatectomy for local recurrence of prostate cancer after carbon ion radiotherapy with surgical video. Owing to adhesion and degeneration after radiotherapy, difficulties in surgery and post-operative complications have been anticipated. However, surgery was feasible without severe peri- and post-operative complications. Salvage robot-assisted radical prostatectomy after carbon ion radiotherapy may be a reasonable therapeutic option. Supplementary Information: The online version contains supplementary material available at 10.1007/s13691-020-00464-w.

DOI： 10.1007/s13691-020-00464-w

Language：English   Publishing type：Research paper (scientific journal)  

We investigated the efficacy and safety profiles of 4-weekly docetaxel for castration-resistant prostate cancer. Patients treated with ≥2 courses of docetaxel chemotherapy (median, 70 mg/m2) between 2008 and 2018 were included. Among 125 Japanese men, 40 (32.0%) and 85 (68.0%) were treated with 3-weekly and 4-weekly regimens, respectively. In the 4-weekly regimen, the risks of progression, treatment failure, and any-cause mortality were comparable to those in the 3-weekly regimen. The incidences of severe adverse events were also similar between the 3-weekly and 4-weekly regimens. These data suggest that the 4-weekly regimen may be an acceptable option for selected patients.

DOI： 10.1080/07357907.2020.1871486

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: We investigated the relationship between the surgical navigation system and postoperative parenchyma preservation volume, and assessed the feasibility of image guided surgery in robot-assisted partial nephrectomy. MATERIALS AND METHODS: We developed surgical navigation with registration between real-time endoscopic images using 3-dimensional virtual reality models for robot-assisted partial nephrectomy. Surgical outcomes of 44 (nonsurgical navigation group) and 102 (surgical navigation group) patients between June 2013 and December 2018 were retrospectively analyzed. To adjust for potential baseline confounders propensity score matching (1:1) was performed. Renal parenchymal preservation rate and extraparenchymal volume with a tumor including functional and oncological outcomes ("trifecta" defined as warm ischemia time of less than 25 minutes, no complications and negative surgical margins; "pentafecta" defined as trifecta plus greater than 90% preservation of estimated glomerular filtration rate at 12 months postoperatively and chronic kidney disease up staging) were evaluated using volumetric analysis and compared. RESULTS: After matching, 42 patients were allocated to each group. No significant differences in baseline characteristics; complications; and intraoperative, trifecta and pentafecta outcomes were observed between the 2 groups. Pathological T stages were significantly different between the groups (T1a/T1b/T2a or more 25/10/7 in the nonsurgical navigation group vs 35/7/0 in the surgical navigation group, p=0.003). Extraparenchymal volumes and parenchyma volume preservation rates were significantly higher in the surgical navigation group (21.4 vs 17.2 ml, p=0.041 and 83.5% vs 90.0%, p=0.042, respectively). Surgical navigation was positively associated with improved parenchyma preservation volume (p=0.003). CONCLUSIONS: Surgical navigation preserves renal parenchyma in robot-assisted partial nephrectomy and may contribute to improvement in postoperative renal function.

DOI： 10.1097/ju.0000000000000709

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/JU.0000000000000709.02

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: To assess surgical skills in robot-assisted partial nephrectomy (RAPN) with and without surgical navigation (SN). METHODS: We employed an SN system that synchronizes the real-time endoscopic image with a virtual reality three-dimensional (3D) model for RAPN and evaluated the skills of two expert surgeons with regard to the identification and dissection of the renal artery (non-SN group, n = 21 [first surgeon n = 9, second surgeon n = 12]; SN group, n = 32 [first surgeon n = 11, second surgeon n = 21]). We converted all movements of the robotic forceps during RAPN into a dedicated vocabulary. Using RAPN videos, we classified all movements of the robotic forceps into direct action (defined as movements of the robotic forceps that directly affect tissues) and connected motion (defined as movements that link actions). In addition, we analyzed the frequency, duration, and occupancy rate of the connected motion. RESULTS: In the SN group, the R.E.N.A.L nephrometry score was lower (7 vs. 6, P = 0.019) and the time to identify and dissect the renal artery (16 vs. 9 min, P = 0.008) was significantly shorter. The connected motions of inefficient "insert," "pull," and "rotate" motions were significantly improved by SN. SN significantly improved the frequency, duration, and occupancy rate of connected motions of the right hand of the first surgeon and of both hands of the second surgeon. The improvements in connected motions were positively associated with SN for both surgeons. CONCLUSION: This is the first study to investigate SN for nephron-sparing surgery. SN with 3D models might help improve the connected motions of expert surgeons to ensure efficient RAPN.

DOI： 10.1007/s11548-019-01980-8

Language：Japanese   Publishing type：Research paper (scientific journal)  

The rate of incidence of febrile infection and the antimicrobial drug used at the time of prostate needle biopsy was examined retrospectively. SPFX (sparfloxacin) 400 mg (January 2007 to March 2010) and LVFX (levofloxacin) 500 mg (April 2010, onward) were administered prophylactically in 1,034 patients undergoing transrectal or transperineal prostate biopsy. One febrile infection occurred and resolved in each group. A single dose of LVFX 500 mg before the procedure effectively prevented febrile infection in both transrectal and transperineal prostate needle biopsy.

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Advances in image navigation surgery

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Biomedical engineering for medical use

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Construction of an image conversion model that outputs 3D organ model images from robot-assisted surgery endoscopic images

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Research and development towards the feasibility of ureteroscopy-assisted robots

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Automatic segmentation of prostate and extracapsular structures in MRI to predict needle deflection in percutaneous prostate intervention.

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Automatic segmentation of prostate and extracapsular structures in MRI to predict needle deflection in percutaneous prostate intervention

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Development of automatic tracking surgical navigation using 3D images and an optical tracking system in the da Vinci Surgical System Xi -Toward standardization of navigation-

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Practice of RAPN using navigation system

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Resectoscope with micromanipulator

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Effectiveness of the navigation system in RAPN -How has navigation changed surgery-

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Surgical Strategy in RAPN: Introduction of 3D Imaging Intraoperative Navigation

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The preservation of more normal renal parenchyma improves the operated renal function decreased by partial nephrectomy.

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Surgical navigation in robot-assisted partial nephrectomy preserves the affected kidney.

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Trends in navigation development in robotic surgery at our hospital

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Investigation of artificial intelligence algorithm used for image support in cystoendoscopy

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Assessment of surgical skills by using surgical navigation in robot-assisted partial nephrectomy.

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Development of next-generation surgical navigation system in Robot-assisted partial nephrectomy

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Novel robotic navigation system

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Augmented Reality to RAPN Augmented Reality Surgical Navigation System Development

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Tumor detection from cystoscopic images by U-Net using Tri-Scan-enhanced images

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Robot-assisted partial nephrectomy ~Ingenuity for preserving renal function~

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Surgical navigation in robot-assisted partial nephrectomy preserves the affected kidney

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Surgical navigation in robot-assisted partial nephrectomy preserves the affected kidney

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Examination of the effectiveness of automatic tracking type surgical navigation in robot-assisted partial nephrectomy

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Ingenuity of renal hilum tumor in our hospital - Surgical navigation in RAPN -

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SURGICAL NAVIGATION USING INTUITIVE IMAGE-TO-PATIENT REGISTRATION FOR ROBOT-ASSISTED PARTIAL NEPHRECTOMY

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Surgical Navigation using Intuitive Image-to-Patient Registration for Robot-Assisted Partial Nephrectomy: Clinical Feasibility study.

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Surgical navigation using intuitive image-to-patient registration for robot-assisted partial nephrectomy: clinical feasibility study

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Expanding RAPN indications through navigation

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Robotic Surgical Navigation Development and Clinical Application at Kyushu University

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Challenge to develop robotic surgical navigation at Kyushu University

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Application of automatic tracking type surgical navigation system to robot-assisted partial nephrectomy and future prospects

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Presentation type：Symposium, workshop panel (nominated)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

腎腫瘍は局在と形態は多岐にわたり,腎血管の数と形態にも個体差がある.従って,ロボット支援腎部分切除術(robot-assisted partial nephrectomy;RAPN)では多様な解剖学的特徴を踏まえ手術のアプローチ方法を術前に計画しておく必要がある.この術前計画において,医療画像から作成された腎癌3D画像は,腎腫瘍や腎血管の情報を視覚的に理解するのに役立ち,この画像を使った3次元的な解剖理解によって腎動脈の遮断予定部位,温存可能な血管の確認と腫瘍切除に伴う尿路の損傷範囲を予測することが可能となり,詳細な術前計画を立てることができる.しかし,3D画像を生成するためには,医用画像解析ワークステーションとソフトウエアが必要となり,これらを扱うための専門知識がユーザーには求められる.また,多様なソフトウエアをクラウドベースまたはサブスクライブされたアプリケーションの中から,ユーザーの用途に合わせて選択しなければならない.そして,ユーザーはソフトウエアを使って腎臓,腫瘍,腎血管や尿路をセグメンテーションしてラベルデータを作成し,このデータをレンダリングして3D画像を作成することになる.従って,ソフトウエアを使った腎癌3D画像の作成は,RAPNのナビゲーションを実施する上で重要でかつ最初のタスクである.しかし,このタスクを遂行する上で,多くの医療者は医療解析ソフトの特性からその操作方法に至るまでの知識と経験を持ち合わせていない場合があり,3D画像を使ったRAPNのナビゲーションの導入についてハードルが高く感じていることがある.本稿では,ナビゲーションを実践するために重要な腎癌3D画像の作成について,最新の知見を含め報告する.(著者抄録)

J-GLOBAL

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