A Guide to Utilizing Iris, a Segmented Three-Dimensional Model, to Improve Surgical Planning and Patient Outcomes During Robotic Partial Nephrectomy

Abstract

Objective: Preoperative surgical planning for localized, small renal masses relies on two-dimensional axial imaging when determining suitability for partial vs radical nephrectomy. Iris, a recently introduced segmentation software, generates interactive three-dimensional virtual models to aid preoperative surgical planning and intraoperative navigation. We present a video of three surgical cases demonstrating different features and applications of the Iris anatomical model and report our initial perioperative results of partial nephrectomies performed using this software and three-dimensional model. Patients and surgical procedure: We retrospectively analyzed all robotic-assisted partial nephrectomy cases at our institution in which Iris was utilized between February 1, 2020, and August 1, 2021. All cases were performed by a single experienced robotic surgeon (M.S.). Baseline patient demographics, perioperative data, and complications were collected and reviewed. Results: In total, 34 consecutive robotic partial nephrectomy cases using the Iris system were included in this series. The mean nephrometry score was 8.2. Total operative time averaged 136.1 min. The mean warm ischemia time was 18.3 min. Arterial clamping was performed in 33 cases (97.1%); selective clamping was used in 12 (35.2%) cases. One intraoperative and one major postoperative complication were observed. Conclusion: Our early experience with the Iris software demonstrates that the three-dimensional model may be a useful adjunct in preoperative surgical planning and intraoperative decision making in patients undergoing robotic partial nephrectomy with moderate and complex nephrometry scores.

Keywords

• Three-dimensional model
• Surgical planning
• Surgical navigation
• Partial nephrectomy
• Robotic surgery