The evolution of image guidance in robotic-assisted laparoscopic prostatectomy (RALP): a glimpse into the future

Joshua Makary*, Danielle C. van Diepen, Ranjan Arianayagam, George McClintock, Jeremy Fallot, Scott Leslie, Ruban Thanigasalam

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

4 Citations (Scopus)


Objectives: To describe the innovative intraoperative technologies emerging to aid surgeons during minimally invasive robotic-assisted laparoscopic prostatectomy. Methods: We searched multiple electronic databases reporting on intraoperative imaging and navigation technologies, robotic surgery in combination with 3D modeling and 3D printing used during laparoscopic or robotic-assisted laparoscopic prostatectomy. Additional searches were conducted for articles that considered the role of artificial intelligence and machine learning and their application to robotic surgery. We excluded studies using intraoperative navigation technologies during open radical prostatectomy and studies considering technology to visualize lymph nodes. Summary of findings: Intraoperative imaging using either transrectal ultrasonography or augmented reality was associated with a potential decrease in positive surgical margins rates. Improvements in detecting capsular involvement may be seen with augmented reality. The benefit, feasibility and applications of other imaging modalities such as 3D-printed models and optical imaging are discussed. Conclusion: The application of image-guided surgery and robotics has led to the development of promising new intraoperative imaging technologies such as augmented reality, fluorescence imaging, optical coherence tomography, confocal laser endomicroscopy and 3D printing. Currently challenges regarding tissue deformation and automatic tracking of prostate movements remain and there is a paucity in the literature supporting the use of these technologies. Urologic surgeons are encouraged to improve and test these advanced technologies in the clinical arena, preferably with comparative, randomized, trials.

Original languageEnglish
Pages (from-to)765-774
Number of pages10
JournalJournal of Robotic Surgery
Issue number4
Publication statusPublished - Aug 2022

Bibliographical note

Publisher Copyright:© 2 021, The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.


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