Use of intraoperative fluorescence to enhance robot-assisted radical prostatectomy

Robot-assisted radical prostatectomy has become the standard of care for the removal of localized prostate cancer. Positive outcomes depend upon the precise removal of the prostate and associated tissue without damage to nearby structures. This process can be aided by fluorescence-guided surgery to enhance the visual contrast between different structures. Here the authors have conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify ten investigations into the use of fluorescence-guided surgery in robot-assisted radical prostatectomy. These studies used fluorescent tracers to identify structures, including the prostate, neurovascular bundle and lymph nodes. These studies demonstrate the safe and effective use of fluorescence-guided surgery in robot-assisted radical prostatectomy and pave the way for further developments in this field. Lay abstract Prostate cancer is the second most common cancer in men worldwide. The mainstay of treatment for earl-stage prostate cancer is surgery. Successful surgery requires the complete removal of the prostate and any surrounding areas to which the cancer has spread. At the same time, delicate neighboring structures that control continence and erectile function must not be disturbed. This operation is most commonly performed with a surgical robot that carries out the surgeon's actions with precision. Despite this, it remains a technically challenging operation that relies on the surgeon's ability to visually discern structures of similar appearance. Fluorescence-guided surgery aims to highlight these key structures such that they stand out to the operating surgeon. Here the authors discuss the current applications of fluorescence-guided surgery in prostate surgery and conclude that it can be a helpful aid to surgery and has the exciting potential to be used to identify cancer cells themselves.