Console-integrated real-time three-dimensional image overlay navigation for robot-assisted partial nephrectomy with selective arterial clamping: early single-centre experience with 17 cases

Furukawa, Junya; Tanaka, Kazushi; Sugimoto, Maki; Fujisawa, Masato

doi:10.1002/rcs.1574

Cited by 39 publications

(25 citation statements)

References 29 publications

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“…It has also been suggested to display overlapped 3D images using the open source processing software (OsiriX) on the surgeon' s console screen through TilePro display for identifying the tumor and vascularization sites, and performing a selective arterial clamping. The combination of this technique with the use of an ultrasound probe will allow for an accurate drawing of the neoplasia profile (9). Augmented reality techniques, however, are still far from being perfect (10): since augmented reality cannot be used in fine anatomy until adequate technique development and mastering has been accomplished, it is all the more crucial to optimize the use of a modality which is safe and reproducible, such as intraoperative ultrasound, possibly implemented by the contrast enhanced ultrasound (CEUS).…”

Section: Discussionmentioning

confidence: 99%

The role of intraoperative ultrasound in small renal mass robotic enucleation

Gunelli

Fiori

Salaris

et al. 2016

Arch Ital Urol Androl

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Introduction: As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. Materials and methods: A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8) using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826). Results: Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). No complications due to the use of the ultrasound probe were observed. Conclusions: The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during surgical dissection.KEY WORDS: Robotic ultrasound probe; Renal tumor; Simple enucleation; Psychomotor skills. SummaryNo conflict of interest declared.

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Section: Discussionmentioning

confidence: 99%

The role of intraoperative ultrasound in small renal mass robotic enucleation

Gunelli

Fiori

Salaris

et al. 2016

Arch Ital Urol Androl

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“…A single trained surgeon (H.M.) performed RAPN for all 70 patients included in this study employing a 3-arm da Vinci Xi robotic system. Before RAPN, 3D images were reconstructed from the digital imaging and communications in medicine (DICOM) data of the contrast-enhanced CT images for each patient using the SYNAPSE VINCENT system (FUJIFILM, Inc., Tokyo, Japan), which were directly visualized on the screen of the surgeon’s console with the TilePro multi-input display functions during RAPN [21]. At our institution, the trans-peritoneal approach is often selected, except for patients with dorsal hilar tumors or a history of intra-peritoneal surgery.…”

Section: Methodsmentioning

confidence: 99%

Significant impact of three-dimensional volumetry of perinephric fat on the console time during robot-assisted partial nephrectomy

et al. 2019

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BackgroundTo assess the impact of volumetry of perinephric fat (PNF) on the perioperative outcomes of robot-assisted partial nephrectomy (RAPN).MethodsBetween 2016 and 2019, a single surgeon performed RAPN for 128 patients with clinical T1a-b renal tumors at our institution, and the 70 most recent patients were included in this study to minimize the effects of surgical experience. PNF was defined as a fatty area around the kidney within the anatomical structures, including the lateroconal fascia, fusion fascia, psoas muscle, lumbar quadrate muscle and diaphragm, and its volume was calculated based on reconstructed three-dimensional computed tomography images using the SYNAPSE VINCENT system.ResultsIn this series, the trifecta and MIC (margin, ischemia and complications) score system outcomes were achieved in 69 (98.6%) and 64 patients (91.4%), respectively. The median PNF volume in the 70 patients was 166.05 cm3, which was significantly correlated with both the body mass index (BMI) and Mayo adhesive probability (MAP) score (correlation coefficient = 0.68 and 0.74, respectively). There was no significant difference in the R.E.N.A.L. nephrometry score, PNF volume or console time during RAPN among 5 groups consisting of 14 consecutive patients. Of several factors examined, the console time was significantly affected by the sex, MAP score and PNF volume, and only the PNF volume was independently associated with the console time.ConclusionEven if performed by an experienced robotic surgeon beyond the initial learning curve, the PNF volume may influence the console time during RAPN.

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“…To facilitate clamping, a novel image-overlay navigation system was developed and used, as previously described [17]. In brief, CT images were manipulated using OsiriX (Pixmeo, Geneva, Switzerland) [18], image processing software dedicated to Digital Imaging and Communications in Medicine (DICOM) images, that was designed for visualization and navigation of multidimensional images.…”

Section: Rns Scoringmentioning

confidence: 99%

Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy

et al. 2014

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Console-integrated real-time three-dimensional image overlay navigation for robot-assisted partial nephrectomy with selective arterial clamping: early single-centre experience with 17 cases

Abstract: RAPN with selective arterial clamping using this innovative imaging system could be a useful alternative to conventional RAPN.

Cited by 39 publications

References 29 publications

The role of intraoperative ultrasound in small renal mass robotic enucleation

The role of intraoperative ultrasound in small renal mass robotic enucleation

Significant impact of three-dimensional volumetry of perinephric fat on the console time during robot-assisted partial nephrectomy

Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy

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