Utilization of a three-dimensional printed kidney model for favorable TRIFECTA achievement in early experience of robot-assisted partial nephrectomy

Artificial Intelligence Based Augmented Reality Navigation in Minimally Invasive Partial Nephrectomy

OBJECTIVE

To explore the role of artificial intelligence based augmented reality intraoperative real-time navigation in minimally invasive partial nephrectomy to standardize renal hilum dissection procedures and improve operative efficiency.

MATERIALS AND METHODS

A three-dimensional (3D) model by intelligent/interactive qualitative and quantitative analysis was created from patient-specific cross-sectional computed tomography imaging, and the semi-transparent picture were holographically projected on the surgeon console in Da Vinci or monitor in laparoscopy. We developed an artificial intelligence auto-matching technique to generate real-time augmented reality (AR) images by one or two points indicated by the surgeon. The size, rotation, and transparency of the three-dimensional model were manipulated automatically to overlap anatomy in the operative field. We performed laparoscopic nephrectomy or robotic-assisted partial nephrectomy utilizing this technique and evaluated the accuracy of renal vascular localization. We developed a renal hilum difficulty score based on this technique and assigned scores to anatomical relationship between arteries and veins.

RESULTS

A total of 105 patients were finally included in this study, with 46 patients underwent partial nephrectomy with AR real-time navigation. In group AR-navigation, a significantly higher rate of patients had lower renal hilum exposure time. Operation time, WIT, estimated blood loss, and complications rates were comparable in both groups. No differences were found in hospital stay, pathological subtype, and stage. Patients were classified into complex and simple renal hilum score groups. Renal hilum exposure time was significantly shorter in the AR real-time navigation group compared to no navigation group, especially in the complex renal hilum score group.

CONCLUSION

AI based intraoperative navigation renders a surgical roadmap, provides a standard renal hilum dissecting procedures, and avoid time consuming or unnecessary renal hilum dissection with relatively low complications rates.

Virtual and augmented reality systems and three-dimensional printing of the renal model-novel trends to guide preoperative planning for renal cancer

Objective

This study aimed to explore the applications of three-dimensional (3D) technology, including virtual reality, augmented reality (AR), and 3D printing system, in the field of medicine, particularly in renal interventions for cancer treatment.

Methods

A specialized software transforms 2D medical images into precise 3D digital models, facilitating improved anatomical understanding and surgical planning. Patient-specific 3D printed anatomical models are utilized for preoperative planning, intraoperative guidance, and surgical education. AR technology enables the overlay of digital perceptions onto real-world surgical environments.

Results

Patient-specific 3D printed anatomical models have multiple applications, such as preoperative planning, intraoperative guidance, trainee education, and patient counseling. Virtual reality involves substituting the real world with a computer-generated 3D environment, while AR overlays digitally created perceptions onto the existing reality. The advances in 3D modeling technology have sparked considerable interest in their application to partial nephrectomy in the realm of renal cancer. 3D printing, also known as additive manufacturing, constructs 3D objects based on computer-aided design or digital 3D models. Utilizing 3D-printed preoperative renal models provides benefits for surgical planning, offering a more reliable assessment of the tumor's relationship with vital anatomical structures and enabling better preparation for procedures. AR technology allows surgeons to visualize patient-specific renal anatomical structures and their spatial relationships with surrounding organs by projecting CT/MRI images onto a live laparoscopic video. Incorporating patient-specific 3D digital models into healthcare enhances best practice, resulting in improved patient care, increased patient satisfaction, and cost saving for the healthcare system.

The use of individualized 3D-printed models on trainee and patient education, and surgical planning for robotic partial nephrectomies

3D printing is a growing tool in surgical education to visualize and teach complex procedures. Previous studies demonstrating the usefulness of 3D models as teaching tools for partial nephrectomy used highly detailed models costing between $250 and 1000. We aimed to create thorough, inexpensive 3D models to accelerate learning for trainees and increase health literacy in patients. Patient-specific, cost-effective ($30-50) 3D models of the affected urologic structures were created using pre-operative imaging of 40 patients undergoing partial nephrectomy at Thomas Jefferson University Hospital (TJUH) between July 2020 and May 2021. Patients undergoing surgery filled out a survey before and after seeing the model to assess patient understanding of their kidney, pathophysiology, surgical procedure, and risks of surgery. Three urological residents, one fellow, and six attendings filled out separate surveys to assess their surgical plan and confidence before and after seeing the model. In a third survey, they ranked how much the model helped their comprehension and confidence during surgery. Patient understanding of all four subjects significantly improved after seeing the 3D model (P < 0.001). The urology residents (P < 0.001) and fellow (P < 0.001) reported significantly increased self-confidence after interacting with the model. Attending surgeon confidence increased significantly after seeing the 3D model (P < 0.01) as well. Cost-effective 3D models are effective learning tools and assist with the evaluation of patients presenting with renal masses, and increase patient, resident, and fellow understanding in partial nephrectomies. Further research should continue to explore the utility of inexpensive models in other urologic procedures.

Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy

Background

We assessed the natural history of renal artery pseudoaneurysm (RAP) after robot-assisted partial nephrectomy (RAPN).

Methods

From May 2016 to September 2020, 106 patients underwent RAPN for renal tumors at our institution. Among 100 patients, excluding 6 who were ineligible for contrast-enhanced computed tomography (CE-CT), 4 underwent renal artery selective embolization (RAE), of which 2 cases were emergency RAE within 7 days after RAPN and the other 2 were prophylactic RAE 8 or more days after RAPN. In 98 patients examined for the clinical course of asymptomatic RAP managed by surveillance, excluding the 2 who underwent emergency RAE, routine CE-CT was performed at 7 days, 1 month and 3 months after RAPN. Factors influencing the occurrence of RAP among these 98 patients, including the 2 who underwent emergency RAE and excluding the 2 who underwent prophylactic RAE, were analyzed by logistic regression analysis.

Results

Median [interquartile range (IOR), range] observation period, age, radiographic tumor size, and maximum diameter of RAP were 20.8 (23.9, 3.0–57.6) months, 63 (18, 22–84) years, 23 (11, 9–48) mm, and 6.6 (5.2, 3.0–16.0) mm, respectively. CE-CT detected 28 RAPs in 23 (23.0%) of 100 patients by 7 days after RAPN and routine CE-CT detected 25 RAPs in 21 (21.4%) of 98 patients excluding 2 who underwent emergency RAE at 7 days after RAPN. RAP was diagnosed by routine CE-CT in 21 (21.4%), 1 (1.0%), and 0 (0%) patients at 7 days, 1 month, and 3 months after RAPN, respectively. In univariate analysis, age [odds ratio (OR) 0.144: 69–84 vs. 22–56 years old, P=0.0179], R.E.N.A.L [radius (tumor size as maximal diameter), exophytic/endophytic properties of tumor, nearness of tumor deepest portion to collecting system or sinus, anterior/posterior descriptor and location relative to polar line] nephrometry score (OR 1.374, P=0.0382), warm ischemic time (OR 1.085, P=0.0393), and renorrhaphy time (OR 1.055, P=0.0408) were significantly associated with the occurrence of RAP. In multivariate analysis, only age (OR 0.124, P=0.0148) was a significant factor.

Conclusions

Asymptomatic RAP up to 15 mm in diameter resolved spontaneously 3 months after RAPN. Young age (under 56 years) may be a factor in the development of RAP.

Three-dimensional (3D) reconstruction and navigation in robotic-assisted partial nephrectomy (RAPN) for renal masses in the solitary kidney: A comparative study

BACKGROUND

Numerous efforts were made to improve renal function and oncologic outcomes in surgery for patients with kidney cancer. We explored new robotic methods in solitary kidneys.

MATERIALS AND METHODS

We prospectively registered and included 16 patients in the 3D-robot-assisted partial nephrectomy (RAPN) group with a solitary kidney (anatomic or functional), and retrospectively identified 25 patients with a solitary kidney who received RAPN also operated by us for comparison.

RESULTS

The rates of global clamping reduced in the 3D-RAPN group (37.5% vs 76%)while selective rates were higher (56.2% vs 20%) (p = 0.028). The mean percentages of Scr increase (+20.2% vs +30.2%, p = 0.045) and eGFR reduction (-16.8% vs -27.1%) as well as rate of opening collecting systems (31.3% vs 72%, p = 0.010) were lower in 3D-RAPN group.

CONCLUSIONS

3D-RAPN less impaired the renal function of patients with a solitary kidney and showed superiority or non-inferiority in other evaluation indexes compared to conventional RAPN.