Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

Hyde, Eoin; Berger, Leslie; Ramachandran, Navin; Hughes-Hallett, Archie; Pavithran, Nevil M.; Tran, Maxine; Ourselin, Sébastien; Bex, Axel; Mumtaz, Faiz

doi:10.1007/s11548-019-01913-5

Cited by 38 publications

(21 citation statements)

References 32 publications

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“…As indicated by the results of previous studies, the present study underlines how use of the appropriate imaging tool is fundamental for precise evaluation of the tumour anatomical complexity in preoperative planning, potentially influencing the intervention strategy as well as the surgical indication [32,33].…”

Section: Discussionmentioning

confidence: 73%

Three‐dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores

et al. 2019

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ObjectivesTo apply the standard PADUA and RENAL nephrometry score variables to three-dimensional (3D) virtual models (VMs) produced from standard bi-dimensional imaging, thereby creating three-dimensional (3D)-based (PADUA and RENAL) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D-based nephrometry score/category, in order to evaluate their predictive role for postoperative complications. Materials and MethodsAll patients with localized renal tumours scheduled for minimally invasive partial nephrectomy (PN) between September 2016 and September 2018 underwent 3D and 2D nephrometry score/category assessments preoperatively. After nephrometry score/category evaluation, all the patients underwent surgery. Chi-squared tests were used to evaluate the individual patients' grouping on the basis of the imaging tool (3D VMs and 2D imaging) used to assess the nephrometry score/category, while Cohen's j coefficient was used to test the concordance between classifications. Receiver-operating characteristic curves were produced to evaluate the sensitivity and specificity of the 3D nephrometry score/category vs the 2D nephrometry score/ category in predicting the occurrence of postoperative complications. A general linear model was used to perform multivariable analyses to identify predictors of overall and major postoperative complications. ConclusionsIn the present study, we showed that 3D VMs were more precise than 2D standard imaging in evaluating the surgical complexity of renal masses according to nephrometry score/ category. This was attributable to a better perception of tumour depth and its relationships with intrarenal structures using the 3D VM, as confirmed by the higher accuracy of the 3D VM in predicting postoperative complications.Additional Supporting Information may be found in the online version of this article: Table S1. Multivariable analysis identifying the preoperative independent predictors of overall complication and major complications for PADUA and RENAL score. 954

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Section: Discussionmentioning

confidence: 73%

Three‐dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores

et al. 2019

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“…As a surgical navigator, a 3Dprinted kidney model can reduce image distortion and enable accurate tumour positioning [12]. However, due to the limitations in this kind of study design, no studies have objectively proved these advantages, as the vast majority of studies have been performed in the areas of surgical planning, [11,[15][16][17][18][19][20][21]. Thus, elucidating the advantages in surgical effectiveness is of paramount importance.…”

Section: Discussionmentioning

confidence: 99%

“…They found the benefits of a 3D-VR model in renal function preservation and postoperative complications. Hyde et al [21] used preoperative interactive 3D-VR models for surgical planning in 25 surgeons. They found that the application of the 3D-VR models resulted in a 19% change in the planned surgical approach and increased surgeon confidence in the surgical decisions in four/five patient datasets.…”

Section: Several Previous Studies Have Reported Console-integrated Realtime 3d Image-only Navigation (Virtual Reconstruction [Vr]mentioning

confidence: 99%

Personalised three‐dimensional printed transparent kidney model for robot‐assisted partial nephrectomy in patients with complex renal tumours (R.E.N.A.L. nephrometry score ≥7): a prospective case‐matched study

et al. 2020

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To evaluate the effectiveness of a three-dimensional (3D) printed transparent kidney model as a surgical navigator for robot-assisted partial nephrectomy (RPN) in patients with complex renal tumours, defined by a R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score of ≥7. Patients and MethodsA total of 80 patients who underwent RPN were included in the present prospective case-matched study (case group [n = 40, application of 3D-printed transparent kidney model during RPN] vs matching group [n = 40, routine protocol]). The RPNs were performed by a single experienced surgeon. The RPN procedure consisted of six steps: (i) preparation of the renal hilar vessel for clamping, (ii) tumour detection and dissection, (iii) robotic ultrasonography, (iv) tumour resection, (v) calyx repair and haemostasis, and (vi) renorrhaphy. The time for each step, console time, and warm ischaemia time were compared between the two groups as a surrogate marker for surgical effectiveness. ResultsBoth groups were well-balanced for all baseline characteristics. The use of the model reduced the console time by~20% compared to the matched group (64.6 vs 78.5 min, P = 0.001). On multivariate logistic regression analysis, tumour radius (P < 0.001) and application of the model (P = 0.009) were identified as significant predictors of a console time of ≤70 min. ConclusionWe established the usefulness of a personalised 3D-printed transparent kidney model for more effective RPNs. Use of the 3D-printed transparent kidney model reduced the operative time even for complex renal tumours and would be expected to broaden the indications for PN.

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“…Out of the 37 studies analyzed, twenty-three reported the usefulness and applications of virtual and printed 3D kidney models in "surgical planning" and "surgical training". Fourteen [36][37][38][39][40][41][42][43][44][45][46][47][48][49] of these were crosssectional studies, mainly surveying the impact of 3D models in understanding renal anatomy and renal tumor by young surgeons, medical students and patients. Table I is a summary of study characteristics of the use of 3D VR models in renal tumors.…”

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review of the clinical value and applications of three-dimensional virtual reconstructions in renal tumors

Moldovanu

Lebovici²,

Buruian

2021

Medicine and Pharmacy Reports

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Three-dimensional (3D) virtual reconstruction (VR) in the medical sciences has emerged as a novel, exciting and effective tool, with promising results for patients, trainees, and even experienced surgeons. The purpose of this review is to summarize the information on the clinical value and applications of 3D VR in renal tumors published in the last ten years. A literary search of PubMed-MEDLINE databases was performed to identify studies reporting the clinical application and usefulness of 3D VR models in renal tumors. Thirty-seven studies were found to meet the selection criteria and were included in the analysis. Most studies have provided a quantitative assessment focused on the accuracy of 3D VR models in replication of anatomy and renal tumor, on measuring 3D tumor volume and on the clinical value and utility of 3D VR in pre-surgical planning and simulation of renal procedures, with significant reductions of intraoperative complications. Fourteen studies provided a qualitative assessment of the usefulness of 3D VR models, with results showing an improved patient understanding of renal anatomy and pathology, improved undergraduate and postgraduate urology education. Moreover, 3D printing technology is a novel technique, and we are currently in the dynamic era, expanding into new surgical nephron-sparing procedures and the development of printed kidneys for transplantation.

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Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

Cited by 38 publications

References 32 publications

Three‐dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores

Three‐dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores

Personalised three‐dimensional printed transparent kidney model for robot‐assisted partial nephrectomy in patients with complex renal tumours (R.E.N.A.L. nephrometry score ≥7): a prospective case‐matched study

A systematic review of the clinical value and applications of three-dimensional virtual reconstructions in renal tumors

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