"It used to be like seeing through one eye. Now, we see for both," summarizes Dr. Antonio Alcaraz, head of the Urology department at the Hospital Clínic de Barcelona. The surgeon and his team have incorporated, for the first time in the world, the three-dimensional vision in the operations of benign prostatic hyperplasia, the most common pathology of this gland. The medical condition, an enlarged prostate that blocks the flow of urine, is operated by endoscopic pathway, introducing tubes with a light source, a camera and surgical tools through the penis. The problem is that, until now, this technique was in 2D and the vision of the optics, more imprecise. The Clinic has now developed a new mechanism that, with a 3D image computer converter, allows this disease to intervene with a three-dimensional vision. The center has already operated 23 patients and has opened the door to incorporate 3D in all endoscopies.
Benign prostatic hyperplasia affects half of men over 50 years. It is not a malignant growth of the gland but it does take a toll on the quality of life of people who suffer from it.The bladder does not empty the urine and those affected need to urinate frequently or urgently, have difficulty urinating or have to get up more times at night to go to the bathroom. "At those ages, how to urinate is a major concern. 30% of men have symptoms that impact their quality of life," says Alcaraz.
Surgical intervention is the alternative to a lifetime medication for these patients. It is, in fact, the most common surgery in the prostate. Only the Clinic performs, every year, more than 200 operations of this type. Almost all cases - except the glands above 200 grams - are intervened endoscopically. "The prostate is like a large tangerine. And it is about removing all the pulp, leaving the peel, to be able to urinate better," exemplifies the urologist. In the operation, the surgeon inserts a viewfinder through the tip of the penis into the urethra, which is the tube that carries urine from the bladder. A laser passes through the viewfinder and burns the area to cut and remove the tissue that blocks the urethra.
But the surgical technique had been stagnant for years and the debate did not go beyond the most appropriate type of laser. "We were standing in 2D vision. Laparoscopy [a little invasive technique that involves introducing several tubes into the abdomen through small incisions] is already in 3D. Robotic surgery, too," says Alcaraz. The problem is that there were no 3D optics so small to fit the tiny endoscopic tubes. In fact, the device that has finally made three-dimensional vision possible in prostate surgeries was initially designed for laparoscopy.
The key to the new Clinic technique is in the Mithras, a device designed by a Chinese company that converts, in real time, the two-dimensional vision into a 3D image. Through complex computer algorithms, the device duplicates the image at the moment and separates it with sufficient degrees of angulation so that the surgeon, wearing 3D glasses, can have a three-dimensional vision. "This gives you more precision in sphincter control and bleeding. It's a qualitative change," warns the urologist.
The Clinic has already intervened 23 patients with this new technique. "The results are unbeatable. The precision it gives us is much better than traditional methods," says Javier Sánchez, another surgeon at the Urology center. "The conceptual change is that of precision. The risk of incontinence is very low and the bleeding, less than 200 cubic centimeters," adds Alcaraz. The technique has been presented at the last congress of the European Society of Urology.
Beyond the benign prostatic hyperplasia, the finding of the Clinic opens the door to incorporate 3D vision in the rest of endoscopies, either with diagnostic or therapeutic functions. "There are small lesions that with 2D vision you may have doubts. The three-dimensional image gives you another perspective. We are going to use 3D systematically," Alcaraz predicts.
However, he admits, there are still things to improve and improve. After all, and waiting for a specific 3D optics, the Mithras is taking its first steps. And it was not even conceived with an endoscopic application. The changes made by the Clinic in the device have allowed 3D to be incorporated into the endoscopy, but there is still a long way to go: "The problem with the converters that had been tested so far was that they took a long time. A delay of seconds or milliseconds is unthinkable. It has to be immediate and this is it. But surely we will have to improve visibility and progress in the system, "says Alcaraz.