Second prize: preliminary experience with the Niris optical coherence tomography system during laparoscopic and robotic prostatectomy.

PURPOSE To evaluate the feasibility of high-resolution optical coherence tomography (OCT) in the identification of neurovascular bundles (NVBs) during laparoscopic and robotic radical prostatectomy (LRP). PATIENTS AND METHODS Between November 2005 and March 2006, 24 patients undergoing transperitoneal laparoscopic or robotic radical prostatectomy were enrolled in this study. Once the bladder was taken down and the prostate mobilized, the Niris imaging system was deployed. In each patient, in-vivo images were obtained to determine the image characteristics of NVBs, adipose tissue, prostate capsule, and endopelvic fascia. The NVB was imaged again in vivo, after the prostate was excised. Ex-vivo images were obtained from the prostate surface to look for the presence or absence of the NVBs and correlated with the surgeon's assessment of the adequacy of nerve sparing. RESULTS From 24 patients, we obtained more than 300 OCT images of tissue structures including endopelvic fascia, prostate capsule, NVBs, fat, lateral pedicles, and lymphatics. These images were found to correlate independently with the surgeon's impression of the tissue being imaged. Preliminary comparison with parallel histologic evaluation was performed in four patients that suggested OCT could help to identify the NVBs and prostate capsule during LRP. CONCLUSIONS In our preliminary experience with the Niris system during LRP, OCT was able to image the NVB in all patients. This could enhance surgical precision during nerve sparing and positively impact potency rates after radical prostatectomy. Further research will be needed, including parallel histologic evaluation and follow-up, to validate the findings of OCT imaging.