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. 2021 Jul-Sep;25(3):e2021.00011.
doi: 10.4293/JSLS.2021.00011.

Application of Three-Dimensional Virtual Reality Models to Improve the Pre-Surgical Plan for Robotic Partial Nephrectomy

Michael McDonald  1 , Joseph D Shirk  2
Affiliations

Application of Three-Dimensional Virtual Reality Models to Improve the Pre-Surgical Plan for Robotic Partial Nephrectomy

Michael McDonald et al. JSLS. 2021 Jul-Sep.

Abstract

Background and objectives: Minimally invasive surgery for renal masses is complex and relies on two-dimensional (2D) computer tomography (CT) and magnetic resonance imaging (MRI) scans for surgical planning. We sought to determine if three-dimensional (3D) virtual reality (VR) models generated from imaging of patients undergoing robotic partial nephrectomy influenced presurgical planning approaches when compared to routine planning.

Methods: The initial 15 patients underwent robotic assisted laparoscopic partial nephrectomy performed by one urologic surgeon. All patients pre-operatively underwent a CT and/or MRI scan. A pre-operative surgical plan was then recorded. 3D VR models were generated from these scans and reviewed. A second surgical plan was developed based on the 3D VR images. A comparison was made between the two studies prior to surgical intervention. All final surgical plans were implemented based on the 3D VR imaging studies.

Results: Six surgical approaches were changed based on the 3D VR images. Two surgical approaches were changed from a transperitoneal to a retroperitoneal approach and two from a retroperitoneal to a transperitoneal approach. Two patients had distinctive renal vasculature related to the renal cancers which were not appreciated on routine scans but were well delineated by VR imaging studies. As a result, the surgical approach for two patients was altered to accommodate the new findings.

Conclusion: Operative planning is paramount when performing robotic partial nephrectomy and developing a 3D surgical approach from 2D imaging can be difficult. Three-dimensional VR models affords the surgeon a 3D view prior to and during surgery and can ensure the selection of the appropriate surgical approach.

Keywords: Carcinoma; Renal cell; Robotic; Surgical planning; Surgical procedures; Virtual reality.

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Conflict of interest statement

Conflict of interests: Joseph D. Shirk is a consultant for Ceevra. Michael McDonald has none.

Figures

Figure 1.
Figure 1.
Figure A (Top Left), Right renal mass, endophytic. Figure B (Bottom Left), Right renal mass clearly seen on renal vein. Figure C (Top Right), Right lower pole renal mass. Figure D (Bottom Right), Accessory lower pole renal artery. Figure A,B same patient. Figure C,D same patient.
Figure 2.
Figure 2.
Magnetic resonance imaging “lower pole medial tumor.” Three-dimensional virtual reality showing posterior tumor.
See this image and copyright information in PMC

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