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

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 pre-surgical 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.