Virtual reality may improve training of renal surgeons

Abstract

By exploiting the extra information available from 3D imaging in a virtual reality environment, surgeons can individualize the pre-planning of surgery on the kidneys.The most frequent kidney cancer in adults is renal cell carcinoma. Certain features limit the successful treatment of this tumor, including resistance to radiotherapy and chemotherapy, so renal surgery is generally the best strategy to cure these patients.Renal surgery is one of the more challenging procedures for today's urologist. Cure with a single procedure is a huge responsibility, especially with the complex anatomy involved and the major complications that can occur as a result of decisions during the surgery. However, partial kidney resections have undeniable advantages with respect to renal function preservation. In particular, minimally invasive procedures (laparoscopic, robotic, cryotherapeutic, and radiofrequency) have quite favorable cure rates, recovery times, medication requirements, blood loss, cosmetic results, and hospitalization lengths. These less invasive techniques also have limitations and additional difficulties for the urologist, including loss of tactile feedback, longer operating times (which impact renal blood supply), and learning curves.Diagnostic imaging with computed tomography (CT) and magnetic resonance imaging (MRI) detects, characterizes and determines the stage of the disease. Other critical information obtained from these studies includes the number and localization of blood vessels, depth of the tumor, multifocality of disease, and involvement of adjacent organs. A comprehensive understanding of these factors allows the urologist to plan the surgery without invasive diagnostic procedures. 1, 2 Other researchers have refined this pre-planning step with the imaging system in a 3D environment. 3 The most frequent application of 3D imaging and virtual reality in urological practice is probably renal surgery (see Figures 1 and 2), as the analysis of tumoral features and anatomy allows the surgeon to design a tailored approach for each particular case. 1, 2, 4 Our group developed a virtual reality model of renal tumor images that a urologist can manipulate on a laptop computer inside the operating room to obtain accurate information about the case. 5 Other groups have also recreated surgical resections of renal tumors using virtual reality. These models allow the surgeon to visualize the spatial relationships of pathological and physiological features in each case, and hence avoid unexpected intraoperative injuries in cases with complex anatomy. [6][7][8] Several techniques incorporating 3D imaging systems are currently used in clinical practice. Development of CT scanners with multi-detectors as well as new hardware and software allows endoscopic virtual navigation through the ureters, which aids in detection of small urothelial malignant lesions. 9 Although this endoscopic navigation is useful, the technique has some tumor detection limitations in comparison with axial images. 10 In other studies, multidetector CT...