Almost half of the patients with testicular cancer develop lymph node metastases in the back of the abdomen (retroperitoneum). Despite chemotherapy, 25% of these patients have residual metastases requiring a surgical procedure to cure: a retroperitoneal lymph node dissection (RPLND). RPLND is complex surgery as metastases are often adhesive and encase blood vessels, nerves and organs. These structures are easily damaged during surgery. Currently, urologists plan RPLND surgery using 2D CT-scans. Unfortunately, 2D CT-scans provide no 3-dimensional anatomical details how metastases relate to surrounding structures. As a result, urologists are unable to anticipate on high-risk situations preoperatively and are forced to make split-second decisions during surgery, leading to a significant risk of complications. Complications include major bleedings delaying recovery and increasing hospital length-of-stay, subfertility, kidney removal and incomplete metastasis resection. These complications can have a permanent impact on the quality-of-life testicular cancer patients.
The ATLAS (VirtuAl RealiTy for preoperative pLAnning of complex retroperitoneal Surgery) project focusses on improved imaging for RPLND surgery as to provide sufficient anatomical details to anticipate on high-risk situations encountered during surgery. The researchers of the Erasmus MC Center for Rare Urinary Tract and Testicular Tumors collaborate with the small enterprise MedicalVR, a company at the forefront 3D Virtual Reality Imaging for surgery. Together, we develop an AI-based algorithm and software for automated delineation of testicular cancer metastases and adjacent anatomical structures in the retroperitoneum. With this software, 3D models can be constructed from the 2D CT images, depicting the patients’ unique anatomy. Studying the 3D model through VR goggles before surgery will help the urologist to improve the surgical outcomes.
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People working on the project