AUA 2018: Intraoperative Console Display and Control of Anatomical Renderings During Robot-Assisted Laparoscopic Partial Nephrectomy

San Francisco, CA USA ( Steven Monda, fourth year medical student from Washington University in St. Louis, presented his center’s research study on the integration of three dimensional (3D), virtual reality (VR) models during robot assisted partial nephrectomy. The inspiration of this research project stemmed from the increased prevalence of 3D renderings during perioperative surgical planning. Though most research centers use 3D printing as the most common approach of surgical planning, which mostly take place during the preoperative assessment, Mr. Monda and his team attempted to use graphical 3D renderings in an intraoperative fashion on the display of the surgical robot console.

To create these images, a research member would take computed tomography (CT) or magnetic resonance imaging (MRI) images of the patients to make .stl files using Vitrea Vital® software. Then, the renderings would be imported into a virtual 3D image using Autodesk Meshmixer®. This model would then be transferred onto the Da Vinci robotic system which could be controlled using a 3Dconnexion® 3D mouse intraoperatively.

This study was particularly interesting because they were able show the feasibility of the technology itself. However, there are some flaws with the data collection. There were no positive margins within the study since the five patients operated one were not compared with robot assisted partial nephrectomy without the VR technology. The only postoperative data point that was collected was estimated blood loss (EBL), which ranged from 50 mL to 150 mL. Additionally, Mr. Monda explained that the EBL results that were presented may have due to the surgeon’s operating technique since they operated using the off-clamp nephrectomy technique rather than on-clamp. Additionally, the surgeon cauterized a large area of the kidney to seal off blood vessels after ligation.

Through this study, though there were no quantifiable data, the researchers determined that 3D renderings may facilitate more efficient and accurate resections. Mr. Monda concluded his presentation by explaining the potential future directions of the study. He and his team plan to compare warm ischemia times, preserved renal parenchyma, and tumor margins in patients of high R.E.N.A.L. nephrometry scores. Additionally, Mr. Monda will ask the surgeon to complete perioperative surveys to quantify the efficiency and accuracy of 3D renderings versus standard robot assisted partial nephrectomy.

Presented by: Steven Monda

Written by: Zachary Valley, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA