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3D MRI-Guided Pelvic Floor Dissection in Bladder Exstrophy: A Single Arm Trial.

Di Carlo HN, et al. J Urol. 2019.


PURPOSE: To determine the safety and efficacy of intraoperative magnetic resonance imaging (MRI) guided surgical reconstruction of bladder exstrophy for identification of the urogenital diaphragm fibers and the thickened muscular attachments between the posterior urethra, bladder plate and pubic rami.

METHODS: Institutional review board and Food and Drug Administration approval was obtained for use of Brainlab® (Munich, Germany) intraoperative MRI-guided navigation of the pelvic floor anatomy during closure of CBE and CE at the authors' institution. Pre-operative pelvic 3D MRI was obtained one day prior to closure in patients having pelvic osteotomies. Intraoperative registration was performed after pre-operative planning with a pediatric radiologist utilizing five anatomic landmarks immediately prior to initiation of surgery. Accuracy of identification of pelvic anatomy was assessed by two pediatric urologic surgeons and one pediatric radiologist.

RESULTS: Forty three patients with CBE and four patients with CE closed at the authors' institution have successfully utilized Brainlab® technology to navigate and guide the dissection of the pelvic floor intraoperatively. All patients had 100% accuracy in correlation of gross anatomic landmarks with 3D MRI identified landmarks intraoperatively, and all have had successful closure without any major complication.

CONCLUSION: Brainlab® intraoperative 3D MRI-guided pelvic floor navigation and dissection is an effective way to accurately identify pelvic anatomy during CBE and CE closure. This technology offers a unique opportunity for surgical skill education in this complex reconstructive operation.


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