Imaging modalities aiding nerve-sparing during radical prostatectomy

Abstract

Nerve-sparing robot-assisted radical prostatectomy has decreased the post-surgical complications of prostate surgery, but has not eliminated it. The ability to view the microstructure will enable better surgical decisions and lead to better post-surgical outcomes. An ideal imaging modality should provide rapid image acquisition, be low cost, and be specific to the tissue being examined. This article aims to review the current literature to compare three main techniques: Multiphoton microscopy (MPM), optical coherence tomography, and confocal microscopy, to see which of these techniques may be best applied in surgical procedures in the future. Embase and Medline were used as the primary databases. Combinations of various key words were used while researching the literature. These included: "Radical prostatectomy,” “nerve-sparing,” “nerve mapping,” “multiphoton microscopy,” “Confocal microscopy,” and “Optical Coherence Tomography.” Thereafter, the relevant results were selected and used in the review. Although optical coherence tomography is a low cost and compact modality, it lacks cellular resolution, while confocal microscopy offers great cellular resolution but lacks depth. MPM, on the other hand, provides sufficient depth and produces high-resolution images. The limitation of MPM is its lack of portability, however the advent of dual-modality MPM may be a way forward.