The Use of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Partial Nephrectomy.

OBJECTIVE To determine whether 3-dimensional virtual reality models of patient-specific anatomy improve outcomes in patients undergoing robotic partial nephrectomy. MATERIALS AND METHODS Computed tomography and magnetic resonance imaging scans for 30 patients undergoing robotic partial nephrectomy were converted to 3-dimensional virtual reality models prior to the patient's operation. These models were then viewed on the surgeon's mobile phone pre- and intraoperatively using a Google Cardboard headset to assist in surgical planning. This group was compared to 30 patients who previously underwent robotic partial nephrectomy. We compared operative time, clamp time, estimated blood loss, hospital stay, complications, and margin status between these groups. We used forward selecting multivariate regression models to create the final model controlling for significant demographic and clinical variables. RESULTS When controlling for case complexity and surgeon, patients with 3-dimensional, virtual reality-assisted surgical planning had significantly lower operative time (141 minutes vs 201 minutes, P < .0001), clamp time (13.2 minutes vs 17.4 minutes, P = .0274), and estimated blood loss (134 cc vs 259 cc, P = .0233). Patients without 3-dimensional, virtual reality-assisted surgical planning were more likely to have a hospital stay of greater than 2 days (odds ratio 5.1, 95% confidence interval 1.0, 26.4). There were no complications or positive margins noted in the VR group. CONCLUSION Use of a 3-dimensional, virtual reality model when performing robotic partial nephrectomy improves key surgical outcome parameters.

[1]  A. Novick,et al.  Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. , 2000, The Journal of urology.

[2]  J. Geng.  Three-dimensional display technologies. , 2013, Advances in optics and photonics.

[3]  A. Shalhav,et al.  Early discharge after laparoscopic or robotic partial nephrectomy: care pathway evaluation , 2014, BJU international.

[4]  L I Iezzoni,et al.  Identifying Complications of Care Using Administrative Data , 1994, Medical care.

[5]  J. Patard,et al.  Indications, techniques, outcomes, and limitations for minimally ischemic and off-clamp partial nephrectomy: a systematic review of the literature. , 2015, European urology.

[6]  Paul Russo,et al.  Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes? , 2009, The Journal of urology.

[7]  Andrew J Vickers,et al.  Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. , 2006, The Lancet. Oncology.

[8]  Robert G Uzzo,et al.  The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. , 2009, The Journal of urology.

[9]  Ashwin Sridhar,et al.  Learning Curves for Robotic Surgery: a Review of the Recent Literature , 2017, Current Urology Reports.

[10]  M. Schonlau,et al.  Renal and cardiovascular morbidity after partial or radical nephrectomy , 2008, Cancer.

[11]  A. Weizer,et al.  Association of RENAL nephrometry score with outcomes of minimally invasive partial nephrectomy , 2013, International journal of urology : official journal of the Japanese Urological Association.

[12]  Raju Thomas,et al.  Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers: a pilot study. , 2014, Urology.

[13]  J. Rolland,et al.  Head-worn displays: a review , 2006, Journal of Display Technology.

[14]  C. Sundaram,et al.  The role of R.E.N.A.L. nephrometry score in the era of robot-assisted partial nephrectomy. , 2013, Journal of endourology.

[15]  Takanori Okoshi.  Three-Dimensional Imaging Techniques , 1976 .

[16]  J. Kim,et al.  Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications. , 2015, Journal of minimally invasive gynecology.

[17]  K. Rha,et al.  Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. , 2015, European urology.

[18]  K. Resnick,et al.  Longer operative time is associated with increased post-operative complications in patients undergoing minimally-invasive surgery for endometrial cancer. , 2017, Gynecologic oncology.

[19]  C. Komninos,et al.  R-LESS partial nephrectomy trifecta outcome is inferior to multiport robotic partial nephrectomy: comparative analysis. , 2014, European urology.

[20]  R. Link,et al.  Utility of patient‐specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot‐assisted laparoscopic partial nephrectomy , 2017, BJU international.

[21]  Surendra B. Kolla,et al.  Interobserver reliability of the RENAL nephrometry scoring system. , 2011, Urology.

[22]  Wei Chen,et al.  Application of Three-Dimensional Visualization Technology in Laparoscopic Partial Nephrectomy of Renal Tumor: A Comparative Study. , 2017, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[23]  C. Gross,et al.  The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy , 2015, Medical care.

[24]  John L. Gore,et al.  Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. , 2012, JAMA.

[25]  Barry G. Blundell,et al.  Volumetric Three-Dimensional Display Systems , 2000 .

[26]  K. Bensalah,et al.  Predictive factors of hemorrhagic complications after partial nephrectomy. , 2014, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[27]  GolabAdam,et al.  Laparoscopic Partial Nephrectomy Supported by Training Involving Personalized Silicone Replica Poured in Three-Dimensional Printed Casting Mold , 2017 .