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We aim to describe a novel technique of augmented reality (AR)-PSMA-3D guided PLND based on preoperative PSMA-PET for real-time identification of LNM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirteen patients with high-risk PCa and miN1-2 or miM1a disease at PSMA-PET were prospectively enrolled. 3D segmentation model including suspicious LNM was created from PSMA-PET images.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Patients underwent RARP with AR-PSMA-3D guided PLND for real-time intraoperative identification of suspicious LNM. Pathologic examination was used as reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key findings and limitations<\/jats:title>\n                    <jats:p>Four (30%) men had suspicious LNM at PSMA-PET outside the field of the PLND template. The AR-PSMA-3D guided PLND allow to dissect each region with suspected LNM at PSMA-PET with no intraoperative complications. Nine (69%) patients had pN1 disease and three (23%) men had nodal metastases outside the PLND template. The sensitivity, specificity, PPV, NPV and AUC of AR-PSMA-3D guided PLND at a per-region analysis were 69%, 90%, 52%, 95% and 0.79, respectively. Limitations: low spatial resolution of PSMA-PET for micro-metastases and the need for manual alignment of the 3D model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and clinical implications<\/jats:title>\n                    <jats:p>AR-PSMA-3D guidance for PLND in patients with miN1-N2-M1a disease at PSMA-PET allows to facilitate the resection of suspicious LNM including those outside the PLND template.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient summary<\/jats:title>\n                    <jats:p>We propose a novel technique combining AR and PSMA-PET 3D models to guide PLND during RARP in PCa patients. The AR-PSMA-3D guidance for PLND allows a promising real-time identification of suspicious nodes, even outside the PLND template.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41391-025-01024-0","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T09:18:39Z","timestamp":1762679919000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Augmented Reality PSMA-3D guided robotic pelvic lymph node dissection (PLND) in prostate cancer patients"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7321-1536","authenticated-orcid":false,"given":"L.","family":"Bianchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Mottaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1240-9391","authenticated-orcid":false,"given":"B.","family":"Bortolani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7818-1356","authenticated-orcid":false,"given":"L.","family":"Cercenelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Farolfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Scarlatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6740-534X","authenticated-orcid":false,"given":"P.","family":"Piazza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ragni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Droghetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Chessa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Salvador","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Gaudiano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Giunchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Barbagallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Borriello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Fiorentino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Castellucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Mosconi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Marcelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Fanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Schiavina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Brunocilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"1024_CR1","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1016\/S0140-6736(20)30314-7","volume":"395","author":"MS Hofman","year":"2020","unstructured":"Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. 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