Augmented reality 3D robot-assisted partial nephrectomy: Tips and tricks to improve surgical strategies and outcomes

Abstract

Objective: In the last years three dimensional virtual models (3DVMs) had a widespread diffusion in the renal surgery field thanks to their more precise representation of anatomical details. Among the different ways to use the 3DVMs, Augmented reality seems one of the most promising thanks to the possibility of its application during both preoperative planning and intraoperative surgical navigation. In this study we show how to create hyper-accuracy 3DVMs and our specifically developed platform to perform Augmented reality Robot-assisted partial nephrectomy Patients and surgical procedure: From our prospectively maintained database we extracted all patients with localized renal mass underwent Augmented reality (AR) RAPN. Preoperatively all patients underwent a multiphase contrast enhanced CT-scan. From that DICOM images hyper-accuracy 3DVMs were built. Then to perform AR, the 3DVMs are overlayed on the endoscopic video of the Da-Vinci remote surgical console, thanks to a dedicated software, named Rviewer. Results: 65 patients were finally included in this analysis. The median tumor size was 50 mm with a PADUA score of 9. Concerning intraoperative variables, a higher rate of selective clamping and enucleation technique were recorded. The positive surgical margin (PSM) rate and the major complications rate (Clavien-Dindo>2) were 2.5 and 2.1%, respectively. The difference between preoperative and postoperative eGFR was not meaningful. The MIC score was gained in 87.3% of patients. Conclusions: In conclusion AR is still constantly evolving but it has already showed to represent a safe and effective application of 3DVMs. Moreover, in this era in which we are pushing through the limits of NSS and surgeons have to manage more large and complex renal mass than before, AR could represent a valid tool to maximize the probability of success and the perioperative outcome of partial nephrectomy.

Keywords

• Three-dimensional imaging
• Robotic surgery
• Nephron-sparing surgery
• Kidney cancer
• Surgical anatomy