{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:13:39Z","timestamp":1789578819359,"version":"build-2803163510"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA273031"],"award-info":[{"award-number":["R01CA273031"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Open access funding provided by SCELC, Statewide California Electronic Library Consortium"},{"DOI":"10.13039\/100013015","name":"Cedars-Sinai Medical Center","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100013015","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The nerve-sparing step of prostatectomy is crucial for post-operative sexual recovery, and excessive countertraction on the neurovascular bundle (NVB) during retraction has been associated with adverse sexual function outcomes. Our objective is to utilize computer vision to quantitatively assess the degree of this countertraction to study its impact on post-operative sexual recovery. Sixty-four nerve-sparing prostatectomy videos were used to extract snapshots prior to and at the maximum point of retraction gestures on the NVB. Semantic image segmentation, conducted with the Computer Vision Annotation Tool (CVAT), was used to label features such as the proportion of tissue grasped relative to retractor size and tissue stretch (measured by percent area increase and angular deviation from baseline). Supervised machine learning models, including Random Forest, Multi-layer Perceptron, and XGBoost, were then developed to predict the likelihood of erections sufficient for intercourse at a 12-month post-operative follow-up. Predictions were based on clinical and surgical gesture features (age, PSA, extent of nerve sparing, and post-operative Gleason scores, number of NVB retractions) alone and in combination with segmentation-derived features. One thousand one hundred four instances of NVB retraction were labeled. For patients with insufficient erectile function for intercourse at the 12-month follow-up, the mean angular deviation, percent area increase, and proportion of tissue grasped were 25.80\u00b0 (SD 13.1), 41.81% (SD 33.3), and 0.310 (SD 0.093), respectively. In contrast, for patients with sufficient erectile function, these values were 21.07\u00b0 (SD 7.4), 20.10% (SD 12.5), and 0.206 (SD 0.127), respectively. Integrating segmentation-derived features into the models enhanced predictive performance, with the AUC increasing from 0.78 (IQR 0.56\u20130.98) to 0.83 (IQR 0.63\u20131.00) for the Random Forest model, from 0.61 (IQR 0.35\u20130.85) to 0.74 (IQR 0.50\u20130.94) for the Multi-layer Perceptron, and from 0.70 (IQR 0.44\u20130.92) to 0.78 (IQR 0.58\u20130.97) for XGBoost. Delicate handling of the neurovascular bundle is crucial for better post-operative sexual recovery, and computer vision can provide an objective assessment of retraction on the NVB, offering insights beyond clinical and gesture features alone.<\/jats:p>","DOI":"10.1007\/s11701-025-02412-3","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T11:31:27Z","timestamp":1748863887000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Computer vision for evaluating retraction of the neurovascular bundle during nerve-sparing prostatectomy"],"prefix":"10.1007","volume":"19","author":[{"given":"Umar","family":"Ghaffar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikke","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atharva","family":"Deo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherine","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy G.","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Heard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Dadashian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carter","family":"Prentice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runzhuo","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey A.","family":"Sonn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin C.","family":"Goh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graciela","family":"Gonzalez-Hernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"issue":"1","key":"2412_CR1","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/MOU.0b013e32835b6602","volume":"23","author":"S Carter","year":"2013","unstructured":"Carter S, Le JD, Hu JC (2013) Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy. Curr Opin Urol. 23(1):88\u201394. https:\/\/doi.org\/10.1097\/MOU.0b013e32835b6602","journal-title":"Curr Opin Urol."},{"issue":"6 Pt 2","key":"2412_CR2","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1111\/j.1464-410X.2011.10565.x","volume":"108","author":"AK Tewari","year":"2011","unstructured":"Tewari AK, Srivastava A, Huang MW, Robinson BD, Shevchuk MM, Durand M et al (2011) Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int. 108(6 Pt 2):984\u201392. https:\/\/doi.org\/10.1111\/j.1464-410X.2011.10565.x","journal-title":"BJU Int."},{"issue":"11","key":"2412_CR3","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1089\/end.2021.0081","volume":"35","author":"SP Basourakos","year":"2021","unstructured":"Basourakos SP, Kowalczyk K, Moschovas MC, Dudley V, Hung AJ, Shoag JE et al (2021) Robot-assisted radical prostatectomy maneuvers to attenuate erectile dysfunction: technical description and video compilation. J Endourol. 35(11):1601\u20139. https:\/\/doi.org\/10.1089\/end.2021.0081","journal-title":"J Endourol."},{"issue":"1","key":"2412_CR4","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1038\/s41746-022-00738-y","volume":"5","author":"R Ma","year":"2022","unstructured":"Ma R, Ramaswamy A, Xu J, Trinh L, Kiyasseh D, Chu TN et al (2022) Surgical gestures as a method to quantify surgical performance and predict patient outcomes. NPJ Digit Med. 5(1):187. https:\/\/doi.org\/10.1038\/s41746-022-00738-y","journal-title":"NPJ Digit Med."},{"issue":"3","key":"2412_CR5","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1016\/j.eururo.2011.05.001","volume":"60","author":"KJ Kowalczyk","year":"2011","unstructured":"Kowalczyk KJ, Huang AC, Hevelone ND, Lipsitz SR, Yu HY, Ulmer WD et al (2011) Stepwise approach for nerve sparing without countertraction during robot-assisted radical prostatectomy: technique and outcomes. Eur Urol. 60(3):536\u201347. https:\/\/doi.org\/10.1016\/j.eururo.2011.05.001","journal-title":"Eur Urol."},{"issue":"4","key":"2412_CR6","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1097\/sle.0000000000001193","volume":"33","author":"S Zhang","year":"2023","unstructured":"Zhang S, Cui XM, Du T, Ma CY, Hu RH, Yuan B et al (2023) Application of a new retraction method in laparoscopic gastrectomy for gastric cancer. Surg Laparosc Endosc Percutan Tech. 33(4):431\u20134. https:\/\/doi.org\/10.1097\/sle.0000000000001193","journal-title":"Surg Laparosc Endosc Percutan Tech."},{"issue":"6","key":"2412_CR7","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.surge.2013.06.004","volume":"11","author":"PR Steele","year":"2013","unstructured":"Steele PR, Curran JF, Mountain RE (2013) Current and future practices in surgical retraction. Surgeon. 11(6):330\u20137. https:\/\/doi.org\/10.1016\/j.surge.2013.06.004","journal-title":"Surgeon."},{"issue":"4","key":"2412_CR8","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s11548-018-1881-9","volume":"14","author":"A Baghdadi","year":"2019","unstructured":"Baghdadi A, Hussein AA, Ahmed Y, Cavuoto LA, Guru KA (2019) A computer vision technique for automated assessment of surgical performance using surgeons\u2019 console-feed videos. Int J Comput Assist Radiol Surg. 14(4):697\u2013707. https:\/\/doi.org\/10.1007\/s11548-018-1881-9","journal-title":"Int J Comput Assist Radiol Surg."},{"issue":"4 Pt 2","key":"2412_CR9","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1111\/j.1743-6109.2010.01804.x","volume":"7","author":"JP Mulhall","year":"2010","unstructured":"Mulhall JP, Bella AJ, Briganti A, McCullough A, Brock G (2010) Erectile function rehabilitation in the radical prostatectomy patient. J Sex Med. 7(4 Pt 2):1687\u201398. https:\/\/doi.org\/10.1111\/j.1743-6109.2010.01804.x","journal-title":"J Sex Med."}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-025-02412-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-025-02412-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-025-02412-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T01:22:03Z","timestamp":1767489723000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-025-02412-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,2]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2412"],"URL":"https:\/\/doi.org\/10.1007\/s11701-025-02412-3","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,2]]},"assertion":[{"value":"18 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Financial interests: A.H. reported consulting fees from Intuitive Surgical Inc. A.G. reported receiving consulting fees from Medtronic. No other financial interests were reported.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"257"}}